Transplant Disparities in Kids

 

Even children can face considerable inequities when it comes to receiving transplants.

This message was driven home in a recent analysis of data from the U.S. Renal Data System from 2000 to 2008 that revealed that the average annual rate of preemptive transplantation was higher among white children with kidney failure than among those who were Hispanic and black. Racial differences were also evident in the type of preemptive transplants children received, where more white patients had living donors (78.8 percent), compared with Hispanics (57.3 percent) and blacks (48.8 percent). Hispanics had a 50 percent and blacks a 56 percent lower rate of preemptive transplants than whites. Differences in the incidence of preemptive transplantation were unexplained by socioeconomic status, as determined by neighborhood poverty and health insurance.

“Among pediatric kidney disease patients in the United States, white patients have a significantly higher rate of getting a kidney transplant without ever starting dialysis compared to blacks and Hispanics,” said Emory University’s Rachel Patzer, PhD, who co-authored the study and presented it at ASN’s Kidney Week. “The reasons for this racial disparity are not entirely clear, but could be due to lower access to health care among minority patients,” she added.

One potential explanation could be that children in underrepresented minority groups may have less access to care, noted ASN’s immediate past president, Joseph Bonventre, MD, PhD. “It is important to raise the awareness of kidney disease in children among general pediatricians so that all children are evaluated and kidney disease can be picked up early enough so that appropriate management can be brought to bear,” he said.

Patzer was also part of a research team that examined racial differences in deaths among children with kidney failure. The study included all kidney failure patients younger than 21 years of age who went on dialysis between January 2000 and September 2008 and did not receive a transplant during the study, which ended in September 2009. The investigators censored patients at death or end of follow-up and excluded patients who received a transplant. They considered neighborhood poverty and health insurance as measures of socioeconomic status.

Among 8146 pediatric kidney failure patients in the study, 896 (9.7 percent) died, and a greater proportion of those who died were black.

“When a child develops end stage kidney disease, their best chance for survival and a good quality of life is to receive a kidney transplant, compared with staying on dialysis. Sadly, some children die before they ever receive a transplant,” said first author Sandra Amaral, MD, also of Emory University.

The effect of race on death was significantly modified by health insurance. Blacks with no health insurance had a 59 percent greater rate of death after developing kidney failure compared with whites, while Hispanics had a significantly lower rate of death compared with the other racial groups regardless of insurance status. Amaral noted that more studies are needed to understand why these differences occur.

“Raising public awareness of kidney disease in both pediatric as well as adult populations and alerting our primary care providers to the signs of early kidney disease may go far to establish a diagnosis at an earlier stage in all racial groups and ultimately result in better outcomes for our patients,” Bonventre said.

April 2012 (Vol. 4, Number 1)