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Racial disparities in paediatric kidney transplantation

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Abstract

Background

Transplantation is the preferred treatment for children with end-stage kidney disease (ESKD). Pre-emptive transplants, those from live donors and with few human leukocyte antigen (HLA) mismatches provide the best outcomes. Studies into disparities in paediatric transplantation to date have not adequately disentangled different transplant types.

Methods

We studied a retrospective cohort of 823 patients aged <18 years who started renal replacement therapy (RRT) in Australia 1990–2011, using the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA). The primary outcomes were time to first kidney transplant and kidney donor type (deceased or living), analysed using competing risk regression.

Results

Caucasian patients were most likely to receive any transplant, due largely to disparities in live donor transplantation. No Indigenous patients received a pre-emptive transplant. Indigenous patients were least likely to receive a transplant from a live donor (sub-hazard ratio 0.41, 95 % confidence interval 0.20–0.82, compared to Caucasians). Caucasian recipients had fewer HLA mismatches, were less sensitised and were more likely to have kidney diseases that could be diagnosed early or progress slowly.

Conclusions

Caucasian paediatric patients are more likely to receive optimum treatment—a transplant from a living donor and fewer HLA mismatches. Further work is required to identify and address barriers to live donor transplantation among minority racial groups.

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Acknowledgements

The authors gratefully acknowledge the staff of renal units throughout Australia and New Zealand for their efforts in submitting information to ANZDATA, and the staff of ANZDATA for maintaining the database and assisting with data retrieval.

Conflict of interest

None.

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Authors and Affiliations

  1. Australia and New Zealand Dialysis and Transplant Registry (ANZDATA), Level 9, East Wing, Royal Adelaide Hospital, Adelaide, South Australia, Australia

    Blair S. Grace, Philip A. Clayton & Stephen P. McDonald

  2. Discipline of Medicine, University of Adelaide, Adelaide, Australia

    Blair S. Grace & Stephen P. McDonald

  3. Department of Nephrology, Sydney Children’s Hospital, Randwick, Australia

    Sean E. Kennedy

  4. School of Women’s and Children’s Health, University of New South Wales, Sydney, New South Wales, Australia

    Sean E. Kennedy

  5. Department of Renal Medicine, Royal Prince Alfred Hospital, Sydney, Australia

    Philip A. Clayton

  6. Sydney Medical School, University of Sydney, Sydney, Australia

    Philip A. Clayton

Authors
  1. Blair S. Grace
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  2. Sean E. Kennedy
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  3. Philip A. Clayton
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  4. Stephen P. McDonald
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Corresponding author

Correspondence to Blair S. Grace.

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Grace, B.S., Kennedy, S.E., Clayton, P.A. et al. Racial disparities in paediatric kidney transplantation. Pediatr Nephrol 29, 125–132 (2014). https://doi.org/10.1007/s00467-013-2572-y

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  • DOI: https://doi.org/10.1007/s00467-013-2572-y

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