Kidney Week

Abstract: TH-OR049

Racial and Ethnic Disparities in Pediatric Kidney Transplant Outcomes in the United States: Have We Made Any Progress over the Last Twenty Years?

Session Information

• Featured Research in Pediatric Nephrology
  October 25, 2018 | Location: 26A, San Diego Convention Center
  Abstract Time: 06:06 PM - 06:18 PM

Category: Pediatric Nephrology

• 1600 Pediatric Nephrology

Authors

• Purnell, Tanjala S., Johns Hopkins University School of Medicine, Baltimore, Maryland, United States

Tanjala S. Purnell, PhD, MPH

• Luo, Xun, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States

Xun Luo,

• Covarrubias, Karina, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States

Karina Covarrubias,

• Crews, Deidra C., Johns Hopkins University School of Medicine, Baltimore, Maryland, United States

Deidra C. Crews,

• Cooper, Lisa A., Johns Hopkins University School of Medicine, Baltimore, Maryland, United States

Lisa A. Cooper,

• Bae, Sunjae, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States

Sunjae Bae,

• Bignall, O. N. Ray, Cincinnati Children’s Hospital Medical Center, Cincinnati , Ohio, United States

O. N. Ray Bignall,

• Henderson, Macey L., Johns Hopkins University School of Medicine, Baltimore, Maryland, United States

Macey L. Henderson,

• Massie, Allan, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States

Allan Massie,

• Boulware, L. Ebony, Duke University School of Medicine, Durham, North Carolina, United States

L. Ebony Boulware,

• Segev, Dorry L., Johns Hopkins University School of Medicine, Baltimore, Maryland, United States

Dorry L. Segev,

Background

A recent JASN study demonstrated dramatic reductions in disparities in adult kidney transplant (KT) outcomes in the US. We examined twenty-year trends in pediatric KT outcomes to determine whether pediatric KT disparities also changed over time.

Methods

Using OPTN data, we performed Cox proportional hazards regression models to compare patient outcomes among 3,295 White, 2,049 Black, and 2,073 Hispanic children (aged 0-17 years) who received a KT in the US between January 1, 1995 and December 31, 2014. We adjusted regression models for differences in recipient, donor, and transplant center factors.

Results

From 1995 to 2014, survival after KT improved for all recipients. (Figure 1) However, racial/ethnic disparities in long-term survival worsened over time (p<0.05 for statistical interaction). In 1995, compared with long-term mortality in White KT recipients, the adjusted hazard ratio (aHR) for Black recipients was 0.89 (95% CI: 0.67, 1.18) and for Hispanic recipients was 0.51 (95% CI: 0.34, 0.76). In 2014, compared with White recipients, the aHR for Black recipients was 1.84 (95% CI: 1.10, 3.07) and for Hispanic recipients was 0.71 (95% CI: 0.37, 1.35).

Conclusion

In stark contrast to the prior findings of reduced disparities for adult KT recipients, we found that disparities in long-term survival among pediatric kidney transplant recipients worsened over the last two decades in the US. Strategies to elucidate and intervene on mechanisms for disparities in long-term outcomes among pediatric recipients are needed.

Funding

• NIDDK Support