Long-term survival among black and Hispanic children after kidney transplant worsened compared with their white counterparts over the past 2 decades, found a study presented at Kidney Week 2018.
Improvements in surgical techniques and immunosuppression strategies have led to substantial improvements in the outcomes for child kidney transplants overall. But whether those improvements have helped close racial and ethnic disparities in child kidney transplant outcomes documented in the 1980s and 1990s was unclear, said Tanjala Purnell, MPH, PhD, assistant professor of surgery in the division of transplantation at Johns Hopkins University School of Medicine in Baltimore. A 2016 study of adult transplant recipients found improvements in outcomes for both white and black transplant recipients over the past 20 years.
Long-term survival among black and Hispanic children after kidney transplant worsened compared with their white counterparts over the past 2 decades, found a study presented at Kidney Week 2018.
Improvements in surgical techniques and immunosuppression strategies have led to substantial improvements in the outcomes for child kidney transplants overall. But whether those improvements have helped close racial and ethnic disparities in child kidney transplant outcomes documented in the 1980s and 1990s was unclear, said Tanjala Purnell, MPH, PhD, assistant professor of surgery in the division of transplantation at Johns Hopkins University School of Medicine in Baltimore. A 2016 study of adult transplant recipients found improvements in outcomes for both white and black transplant recipients over the past 20 years.
“We were very encouraged by those [results] and we wanted to see if we saw any similar trends for children,” Purnell said.
Using data from the Scientific Registry of Transplant Recipients, she and her colleagues identified 7417 kidney transplants in individuals aged 0 to 17 between 1995 and 2014. The average age at transplant thoughout that time period was 11 to 12 years.
Starting from 1995, they found that black and Hispanic children spent more years on dialysis and were less likely to receive a preemptive transplant than their white counterparts. They were also less likely to have private insurance. Black and Hispanic children were more likely to glomerular disease. At that time, Hispanic children actually had a survival advantage compared with their white counterparts, but mortality for black children was higher in the first years posttransplant and increased in the years following transplant.
But by 2011, Purnell and her colleagues found that racial and ethnic disparities actually worsened. This suggests that white children may be disproportionately benefiting from improved transplant care, Purnell noted.
“We now find that the gap between black and white children in terms of mortality has actually widened instead of narrowing,” Purnell said.
When the data were adjusted for potential confounders, they found no difference in mortality in the 5 years posttransplant between racial and ethnic groups, but disparities in long-term outcomes actually grew for black children and Hispanic children. The gap widened significantly as transplant recipients transitioned into adulthood, Purnell noted. This may suggest that black and Hispanic children, who are disproportionately covered by public insurance, may be losing access to coverage or care.
“Our findings highlight the need to identify mechanisms explaining why we might see these results so we can intervene and improve these outcomes,” Purnell said.
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