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An overview of disparities and interventions in pediatric kidney transplantation worldwide

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Abstract

Despite the stated goals of the transplant community and the majority of organ allocation systems, persistent racial disparities in pediatric kidney transplantation exist throughout the world. These disparities are evident in both living and deceased donor kidney transplantation and are independent of any clinical differences between racial groups. The reasons for these persistent disparities are multifactorial, reflecting both patient and provider barriers to care. In this review, we examine the most current findings regarding disparities in pediatric kidney transplantation and consider interventions which may help reduce those disparities.

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Notes

  1. Due to the relatively short wait times for pediatric kidney transplantation, many patients listed receive transplants before the year-end data are compiled. The racial and ethnic composition of patients on the transplant list is based on the composition of the list at the end of the year for each of the years reported.

  2. See 1 above.

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Acknowledgments

The data reported in the USRDS 2013 report were supplied by the USRDS. The interpretation and reporting of these data are the responsibility of the author(s) and in no way should be seen as an official policy or interpretation of the U.S. government. The data and analyses reported in the 2011 and 2012 Annual Data Report of the U.S. Organ Procurement and Transplantation Network and the SRTR have been supplied by UNOS and the Minneapolis Medical Research Foundation under contract with the U.S. Department of Health and Human Services/Health Resources and Services Administration. The authors alone are responsible for reporting and interpreting these data; the views expressed herein are those of the authors and not necessarily those of the U.S. government. The contents do not represent the views of the Department of Veterans Affairs or the United States Government. The work of Dr. Freeman on this paper was supported by Grant #T32DKK091202 from the National Institute of Diabetes, Digestive and Kidney Disease and for Dr. Myaskovsky by Grant #R01DK081325 from the National Institute of Diabetes, Digestive and Kidney Disease, and Grants #IIR 06-220 and #CIN 13-405 from the Veterans Affairs Health Services Research and Development Service.

Author information

Authors and Affiliations

  1. Division of Pediatric Nephrology and Hypertension, Penn State Hershey Children’s Hospital, Mail Code H085, 500 University Drive, Hershey, PA, 17033, USA

    Michael A. Freeman

  2. Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, University Drive (151C), Pittsburgh, PA, 15240, USA

    Larissa Myaskovsky

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  1. Michael A. Freeman
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Corresponding author

Correspondence to Michael A. Freeman.

Additional information

Answers to questions

1): e

2): d

3): b

4): a

5): b

Questions (answers are provided following the Reference list)

Questions (answers are provided following the Reference list)

  1. 1)

    For patients in Belgium and the Netherlands, what is the difference between native and immigrant children in the median time from initiating dialysis until receiving a kidney transplantation?

    1. a)

      2 months

    2. b)

      4 months

    3. c)

      6 months

    4. d)

      8 months

  2. 2)

    Changing the organ allocation system is one means of addressing disparities in kidney transplantation. One such change was the “Share-35” system implemented by the USA in 2005. What effect did this change have on racial disparities in pediatric kidney transplantation in the USA?

    1. a)

      It had no effect

    2. b)

      It reduced disparities in DDKT, but increased disparities in LDKT

    3. c)

      It increased disparities in both DDKT and LDKT

    4. d)

      It reduced disparities in LDKT, but increased disparities in DDKT

  3. 3)

    Concerns of non-adherence are often cited as a reason to delay kidney transplantation. In the two studies of non-adherence in the pre-transplant ESRD population cited in this review, what was the approximate rate of non-adherence identified?

    1. a)

      10 %

    2. b)

      20 %

    3. c)

      30 %

    4. d)

      40 %

  4. 4)

    What percentage of Australian aboriginal children underwent pre-emptive renal transplantation between 1990 and 2011?

    1. a)

      0 %

    2. b)

      10 %

    3. c)

      20 %

    4. d)

      30 %

  5. 5)

    One factor associated with poor transplant outcomes is non-adherence. In studies of the U.S. pediatric transplantation population, which of the following has been found to be an independent predictor of non-adherence?

    1. a)

      Racial or ethnic identification

    2. b)

      Reliance on public insurance

    3. c)

      Increased SES

    4. d)

      Younger age

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Freeman, M.A., Myaskovsky, L. An overview of disparities and interventions in pediatric kidney transplantation worldwide. Pediatr Nephrol 30, 1077–1086 (2015). https://doi.org/10.1007/s00467-014-2879-3

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