Evaluation of Racial Disparities in Pediatric Kidney Transplant.

Abstract

Prior studies have demonstrated that socioeconomic status (SES) influences racial disparities in adult kidney transplant (KTX) recipients, but there are limited analyses studying this in pediatric KTX and a paucity of data examining psychosocial issues on racial disparities. METHODS: This was a longitudinal cohort study of all pediatric KTX (<21 yo) transplanted at a single-center between July 1999 and Dec 2013. Detailed sociodemographics, psychological, family and clinical variables were collected from medical records. Univariate and multivariable analyses were conducted to determine predominant differences between racial cohorts (African-American [AA] vs. non-AA) and factors associated with outcomes. RESULTS: 175 pediatric KTX were included, 46% were AA. On average, AA recipients lived closer to the transplant center (102±65 vs. 133±72 miles, p=0.004), were less likely to receive a living donor transplant (19% vs. 50%, p<0.001) and were on dialysis longer (1.0±0.9 vs. 0.6±0.8 yrs, p=0.006). After transplant, AA recipients were 3.4 times more likely to experience (95% CI 1.6-7.3) graft loss (see Figure 1). AA patients had higher mean SCr (2.6±2.5 vs. 1.2±0.7 mg/dL, p<0.001) and had higher rates of rejection (43% vs. 18%, p<0.001), medication non-adherence (26% vs. 12%, p=0.015), disruptions in parenting (12% vs. 1%, p=0.002), and family insurance/monetary issues (17% vs. 5%, p=0.011). After adjusting for donor type, DGF, acute rejection, SES and family issues, the influence of AA race on graft loss was significantly reduced, but not completely abrogated (adjusted OR 1.6 95% CI 0.7-4.1). Patients between 18-21 yo had a 50% higher risk of graft loss as compared to those <18 yo; however this risk was similar between AA and non-AA patients. CONCLUSIONS: Pediatric AA KTX patients continue to experience a disproportionately higher rate of graft loss, which is moderately explained by differences in donor type, immunologic risk, socioeconomics and family-related issues; however, these risks do not fully explain the racial disparities.Figure: No Caption available.