Racial Disparities in Access to and Outcomes of Kidney Transplantation in Children, Adolescents, and Young Adults: Results From the ESPN/ERA-EDTA (European Society of Pediatric Nephrology/European Renal Association-European Dialysis and Transplant Association) Registry.
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BORIS DOI
Date of Publication
February 2016
Publication Type
Article
Division/Institute
Contributor
Tjaden, Lidwien A | |
Noordzij, Marlies | |
van Stralen, Karlijn J | |
Raes, Ann | |
Cornelissen, Elisabeth A M | |
O'Brien, Catherine | |
Papachristou, Fotios | |
Schaefer, Franz | |
Groothoff, Jaap W | |
Jager, Kitty J |
Series
American Journal of Kidney Diseases
ISSN or ISBN (if monograph)
0272-6386
Publisher
W.B. Saunders
Language
English
Publisher DOI
PubMed ID
26561356
Uncontrolled Keywords
Description
BACKGROUND
Racial disparities in kidney transplantation in children have been found in the United States, but have not been studied before in Europe.
STUDY DESIGN
Cohort study.
SETTING & PARTICIPANTS
Data were derived from the ESPN/ERA-EDTA Registry, an international pediatric renal registry collecting data from 36 European countries. This analysis included 1,134 young patients (aged ≤19 years) from 8 medium- to high-income countries who initiated renal replacement therapy (RRT) in 2006 to 2012.
FACTOR
Racial background.
OUTCOMES & MEASUREMENTS
Differences between racial groups in access to kidney transplantation, transplant survival, and overall survival on RRT were examined using Cox regression analysis while adjusting for age at RRT initiation, sex, and country of residence.
RESULTS
868 (76.5%) patients were white; 59 (5.2%), black; 116 (10.2%), Asian; and 91 (8.0%), from other racial groups. After a median follow-up of 2.8 (range, 0.1-3.0) years, we found that black (HR, 0.49; 95% CI, 0.34-0.72) and Asian (HR, 0.54; 95% CI, 0.41-0.71) patients were less likely to receive a kidney transplant than white patients. These disparities persisted after adjustment for primary renal disease. Transplant survival rates were similar across racial groups. Asian patients had higher overall mortality risk on RRT compared with white patients (HR, 2.50; 95% CI, 1.14-5.49). Adjustment for primary kidney disease reduced the effect of Asian background, suggesting that part of the association may be explained by differences in the underlying kidney disease between racial groups.
LIMITATIONS
No data for socioeconomic status, blood group, and HLA profile.
CONCLUSIONS
We believe this is the first study examining racial differences in access to and outcomes of kidney transplantation in a large European population. We found important differences with less favorable outcomes for black and Asian patients. Further research is required to address the barriers to optimal treatment among racial minority groups.
Racial disparities in kidney transplantation in children have been found in the United States, but have not been studied before in Europe.
STUDY DESIGN
Cohort study.
SETTING & PARTICIPANTS
Data were derived from the ESPN/ERA-EDTA Registry, an international pediatric renal registry collecting data from 36 European countries. This analysis included 1,134 young patients (aged ≤19 years) from 8 medium- to high-income countries who initiated renal replacement therapy (RRT) in 2006 to 2012.
FACTOR
Racial background.
OUTCOMES & MEASUREMENTS
Differences between racial groups in access to kidney transplantation, transplant survival, and overall survival on RRT were examined using Cox regression analysis while adjusting for age at RRT initiation, sex, and country of residence.
RESULTS
868 (76.5%) patients were white; 59 (5.2%), black; 116 (10.2%), Asian; and 91 (8.0%), from other racial groups. After a median follow-up of 2.8 (range, 0.1-3.0) years, we found that black (HR, 0.49; 95% CI, 0.34-0.72) and Asian (HR, 0.54; 95% CI, 0.41-0.71) patients were less likely to receive a kidney transplant than white patients. These disparities persisted after adjustment for primary renal disease. Transplant survival rates were similar across racial groups. Asian patients had higher overall mortality risk on RRT compared with white patients (HR, 2.50; 95% CI, 1.14-5.49). Adjustment for primary kidney disease reduced the effect of Asian background, suggesting that part of the association may be explained by differences in the underlying kidney disease between racial groups.
LIMITATIONS
No data for socioeconomic status, blood group, and HLA profile.
CONCLUSIONS
We believe this is the first study examining racial differences in access to and outcomes of kidney transplantation in a large European population. We found important differences with less favorable outcomes for black and Asian patients. Further research is required to address the barriers to optimal treatment among racial minority groups.
File(s)
| File | File Type | Format | Size | License | Publisher/Copright statement | Content | |
|---|---|---|---|---|---|---|---|
| Tjaden AmJKidneyDis 2016.pdf | text | Adobe PDF | 668.04 KB | publisher | published | ||
| Tjaden AmJKidneyDis 2016_postprint.pdf | text | Adobe PDF | 1.24 MB | Attribution-NonCommercial-NoDerivatives (CC BY-NC-ND 4.0) | accepted |