TY - JOUR
T1 - 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
AU - Tjaden, Lidwien A.
AU - Noordzij, Marlies
AU - van Stralen, Karlijn J.
AU - Kuehni, Claudia E.
AU - Raes, Ann
AU - Cornelissen, Elisabeth A. M.
AU - O'Brien, Catherine
AU - Papachristou, Fotios
AU - Schaefer, Franz
AU - Groothoff, Jaap W.
AU - Jager, Kitty J.
PY - 2016
Y1 - 2016
N2 - 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. (C) 2016 by the National Kidney Foundation, Inc
AB - 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. (C) 2016 by the National Kidney Foundation, Inc
U2 - https://doi.org/10.1053/j.ajkd.2015.09.023
DO - https://doi.org/10.1053/j.ajkd.2015.09.023
M3 - Article
C2 - 26561356
SN - 0272-6386
VL - 67
SP - 293
EP - 301
JO - American Journal of Kidney Diseases
JF - American Journal of Kidney Diseases
IS - 2
ER -