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Abstract: FR-PO1173

Trends in Living Donation by Race/Ethnicity in Pediatric ESRD

Session Information

  • Pediatric Nephrology - I
    October 26, 2018 | Location: Exhibit Hall, San Diego Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Pediatric Nephrology

  • 1600 Pediatric Nephrology

Authors

  • Amaral, Sandra, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
  • McCulloch, Charles E., University of California San Francisco, San Francisco, California, United States
  • Brunson, Celina, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
  • Winnicki, Erica, University of California San Francisco, San Francisco, California, United States
  • Roll, Garrett R., University of California San Francisco, San Francisco, California, United States
  • Lee, Brian K., University of California San Francisco, San Francisco, California, United States
  • Ku, Elaine, University of California San Francisco, San Francisco, California, United States
Background

Living donation is the best treatment option for children with ESRD, yet living donation rates have declined. With increased knowledge about living donor (LD) risk, racial/ethnic disparities in LD rates for children may have increased.

Methods

We performed a retrospective cohort study of children <18 yrs with incident ESRD 1995-2015 in the US Renal Data System. Using Cox models, we examined associations between race/ethnicity, LD transplant rates and changes over time, adjusting for recipient and donor factors. We also examined donor-recipient relationships by race/ethnicity.

Results

Among 14,926 children, 46.8% received LD transplants. Overall, LD rates declined by 3%/yr since 1995, however the LD rates for Asian children remained stable. Notably, differences in LD rates by race/ethnicity persisted (Fig. 1). Compared with non-Hispanic whites (NHW), Hispanic children were 50% less likely (HR 0.50 (0.45-0.55)), Asians 57% less likely (HR 0.43(0.35-0.52)) and Blacks 70% less likely (HR 0.30 (0.27-0.34)) to receive LD transplant within 2 yrs. of ESRD onset. While 96% of NHW recipients had white donors, only 59% of Asian recipients had Asian donors (p<0.001). Asian recipients were more likely to have non-related donors and Black recipients were less likely to have parents as donors (p< 0.001, Table 1).

Conclusion

Stark racial/ethnic disparities in pediatric access to LD transplant persist. Differences in donor-recipient relationships as contributors to these disparities should be further explored.

Fig.1. Time trends in LD transplant by race/ethnicity, 1995-2015.

Table 1. Donor-recipient characteristics by race/ethncity.