Pediatric Nephrology

, Volume 29, Issue 1, pp 125–132

Racial disparities in paediatric kidney transplantation

  • Blair S. Grace
  • Sean E. Kennedy
  • Philip A. Clayton
  • Stephen P. McDonald
Original Article

Abstract

Background

Transplantation is the preferred treatment for children with end-stage kidney disease (ESKD). Pre-emptive transplants, those from live donors and with few human leukocyte antigen (HLA) mismatches provide the best outcomes. Studies into disparities in paediatric transplantation to date have not adequately disentangled different transplant types.

Methods

We studied a retrospective cohort of 823 patients aged <18 years who started renal replacement therapy (RRT) in Australia 1990–2011, using the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA). The primary outcomes were time to first kidney transplant and kidney donor type (deceased or living), analysed using competing risk regression.

Results

Caucasian patients were most likely to receive any transplant, due largely to disparities in live donor transplantation. No Indigenous patients received a pre-emptive transplant. Indigenous patients were least likely to receive a transplant from a live donor (sub-hazard ratio 0.41, 95 % confidence interval 0.20–0.82, compared to Caucasians). Caucasian recipients had fewer HLA mismatches, were less sensitised and were more likely to have kidney diseases that could be diagnosed early or progress slowly.

Conclusions

Caucasian paediatric patients are more likely to receive optimum treatment—a transplant from a living donor and fewer HLA mismatches. Further work is required to identify and address barriers to live donor transplantation among minority racial groups.

Keywords

Australian Aborigine Competing risks Kidney transplantation Organ donation Paediatric 

References

  1. 1.
    Anthony SJ, Pollock Barziv S, Ng VL (2010) Quality of life after pediatric solid organ transplantation. Pediatr Clin North Am 57:559–574PubMedCrossRefGoogle Scholar
  2. 2.
    McDonald SP, Craig JC (2004) Long term survival of children with end-stage renal disease. N Engl J Med 350:2654–2662PubMedCrossRefGoogle Scholar
  3. 3.
    Park KS, Hwang YJ, Cho MH, Ko CW, Ha IS, Kang HG, Cheong HI, Park YS, Lee YJ, Lee JH, Cho HY (2012) Quality of life in children with end-stage renal disease based on a PedsQL ESRD module. Pediatr Nephrol 27:2293–2300PubMedCrossRefGoogle Scholar
  4. 4.
    Rees L (2009) Long-term outcome after renal transplantation in childhood. Pediatr Nephrol 24:475–484PubMedCrossRefGoogle Scholar
  5. 5.
    Kennedy SE, Mackie FE, Rosenberg AR, McDonald SP (2006) Waiting time and outcome of kidney transplantation in adolescents. Transplantation 82:1046–1050PubMedCrossRefGoogle Scholar
  6. 6.
    Sinha R, Marks SD (2010) Comparison of parameters of chronic kidney disease following paediatric preemptive versus non-preemptive renal transplantation. Pediatr Transplant 14:583–588PubMedCrossRefGoogle Scholar
  7. 7.
    McTaggart S, Dent H, Kennedy S, Briggs N, Hurst K, McDonald S (2012) Pediatric report. In: McDonald S, Hurst K (eds) ANZDATA Registry Report 2011. Australia and New Zealand Dialysis and Transplant Registry, Adelaide. Available at: www.anzdata.org.au
  8. 8.
    Transplantation Society of Australia and New Zealand (TSANZ) (2011) Organ transplantation from deceased donors: consensus statement on eligibility criteria and allocation protocols. Version 1.1. TSANZ, Sydney. Available at: www.tsanz.com.au
  9. 9.
    Patzer RE, Amaral S, Klein M, Kutner NG, Perryman JP, Gazmararian JA, McClellan WM (2012) Racial disparities in pediatric access to kidney transplantation: does socioeconomic status play a role? Am J Transplant 12:369–378PubMedCrossRefGoogle Scholar
  10. 10.
    Samuel SM, Tonelli MA, Foster BJ, Alexander RT, Nettel-Aguirre A, Soo A, Hemmelgarn BR (2011) Survival in pediatric dialysis and transplant patients. Clin J Am Soc Nephrol 6:1094–1099PubMedCrossRefGoogle Scholar
  11. 11.
    Tromp WF, Cransberg K, van der Lee JH, Bouts AH, Collard L, Van Damme-Lombaerts R, Godefroid N, Van Hoeck KJ, Koster-Kamphuis L, Lilien MR, Raes A, Ranguelov N, Groothoff JW (2012) Fewer pre-emptive renal transplantations and more rejections in immigrant children compared to native Dutch and Belgian children. Nephrol Dial Transplant 27:2588–2593PubMedCrossRefGoogle Scholar
  12. 12.
    Furth SL, Garg PP, Neu AM, Hwang W, Fivush BA, Powe NR (2000) Racial differences in access to the kidney transplant waiting list for children and adolescents with end-stage renal disease. Pediatrics 106:756–761PubMedCrossRefGoogle Scholar
  13. 13.
    Grace BS, Clayton P, Cass A, McDonald S (2012) Transplantation rates for live-donor, but not deceased-donor kidneys vary with socio-economic status in Australia. Kidney Int 83:138–145PubMedCrossRefGoogle Scholar
  14. 14.
    Australian Bureau of Statistics (ABS) (2009) Experimental estimates and projections, Aboriginal and Torres Strait Islander Australians, 1991 to 2021. ABS Series 3238. ABS, Canberra. Available at: http://www.abs.gov.au
  15. 15.
    Australian Bureau of Statistics (ABS) (2012) Australian demographic statistics. 2012. ABS Series 3101. ABS, Canberra. Available at: http://www.abs.gov.au
  16. 16.
    McDonald SP, Russ GR (2003) Current incidence, treatment patterns and outcome of end-stage renal disease among indigenous groups in Australia and New Zealand. Nephrology 8:42–48PubMedCrossRefGoogle Scholar
  17. 17.
    White A, Wong W, Sureshkumur P, Singh G (2010) The burden of kidney disease in Indigenous children of Australia and New Zealand, epidemiology, antecedent factors and progression to chronic kidney disease. J Paediatr Child Health 46:504–509PubMedCrossRefGoogle Scholar
  18. 18.
    Smylie J, Crengle S, Freemantle J, Taualii M (2010) Indigenous birth outcomes in Australia, Canada, New Zealand and the United States—an overview. Open Womens Health J 2010:7–17CrossRefGoogle Scholar
  19. 19.
    Caskey F, Ravanan R (2012) Access to kidney transplantation in Australia: does equal mean equitable? Kidney Int 83:18–20CrossRefGoogle Scholar
  20. 20.
    Williams RL (2000) A note on robust variance estimation for cluster-correlated data. Biometrics 56:645–646PubMedCrossRefGoogle Scholar
  21. 21.
    Fine J, Gray R (1999) A proportional hazards model for the subdistribution of a competing risk. J Am Stat Assoc 94:496–509CrossRefGoogle Scholar
  22. 22.
    Yeates KE, Cass A, Sequist TD, McDonald SP, Jardine MJ, Trpeski L, Ayanian JZ (2009) Indigenous people in Australia, Canada, New Zealand and the United States are less likely to receive renal transplantation. Kidney Int 76:659–664PubMedCrossRefGoogle Scholar
  23. 23.
    Muneeruddin S, Chandar J, Abitbol CL, Seeherunvong W, Freundlich M, Ciancio G, Burke GW, Zilleruelo G (2010) Two decades of pediatric kidney transplantation in a multi-ethnic cohort. Pediatr Transplant 14:667–674PubMedCrossRefGoogle Scholar
  24. 24.
    Pitcher GJ, Beale PG, Bowley DM, Hahn D, Thomson PD (2006) Pediatric renal transplantation in a South African teaching hospital: a 20-year perspective. Pediatr Transplant 10:441–448PubMedCrossRefGoogle Scholar
  25. 25.
    Samuel SM, Foster BJ, Tonelli MA, Nettel-Aguirre A, Soo A, Alexander RT, Crowshoe L, Hemmelgarn BR (2011) Dialysis and transplantation among Aboriginal children with kidney failure. Can Med Assoc J 183:E665–E672CrossRefGoogle Scholar
  26. 26.
    Vos T, Barker B, Begg SJ, Stanley L, Lopez AD (2009) Burden of disease and injury in aboriginal and Torres Strait Islander peoples: the Indigenous health gap. Int J Epidemiol 38:470–477PubMedCrossRefGoogle Scholar
  27. 27.
    Grace B, Clayton P, Cass A, McDonald S (2012) Socio-economic status and incidence of renal replacement therapy: a retrospective cohort study of Australian patients. Nephrol Dial Transplant 27:4173–4180PubMedCrossRefGoogle Scholar
  28. 28.
    Grubbs V, Gregorich SE, Perez-Stable EJ, Hsu CY (2009) Health literacy and access to kidney transplantation. Clin J Am Soc Nephrol 4:195–200PubMedCrossRefGoogle Scholar
  29. 29.
    Navaneethan SD, Singh S (2006) A systematic review of barriers in access to renal transplantation among African Americans in the United States. Clin Transplant 20:769–775PubMedCrossRefGoogle Scholar
  30. 30.
    Wakefield CE, Reid J, Homewood J (2011) Religious and ethnic influences on willingness to donate organs and donor behavior: an Australian perspective. Prog Transplant 21:161–168PubMedGoogle Scholar
  31. 31.
    Bratton C, Chavin K, Baliga P (2011) Racial disparities in organ donation and why. Curr Opin Organ Transplant 16:243–249PubMedCrossRefGoogle Scholar
  32. 32.
    Chesney RW, Wyatt RJ (2003) Racial disparities in renal transplantation in children. Pediatrics 112:409–411PubMedCrossRefGoogle Scholar
  33. 33.
    Amaral S, Patzer RE, Kutner N, McClellan W (2012) Racial disparities in access to pediatric kidney transplantation since Share 35. J Am Soc Nephrol 23:1069–1077PubMedCrossRefGoogle Scholar
  34. 34.
    Samuel SM, Hemmelgarn B, Nettel-Aguirre A, Foster BJ, Soo A, Alexander RT, Tonelli M (2012) Association between residence location and likelihood of transplantation among pediatric dialysis patients. Pediatr Transplant 16:735–741PubMedCrossRefGoogle Scholar
  35. 35.
    Kennedy SE, Bailey R, Kainer G (2012) Causes and outcome of late referral of children who develop end-stage kidney disease. J Paediatr Child Health 48:253–258PubMedCrossRefGoogle Scholar
  36. 36.
    Van Stralen KJ, Verrina E, Belingheri M, Dudley J, Dusek J, Grenda R, Macher M-A, Puretic Z, Rubic J, Rudaititis S, Rudin C, Schaefer F, Jager K (2013) Impact of graft loss among kidney diseases with a high risk of post-transplant recurrence in the paediatric population. Nephrol Dial Transplant 28:1031–1038PubMedCrossRefGoogle Scholar
  37. 37.
    Stewart JH, McCredie MRE, McDonald SP (2004) The incidence of treated end-stage renal disease in New Zealand Maori and Pacific Island people and in indigenous Australians. Nephrol Dial Transplant 19:678–685PubMedCrossRefGoogle Scholar
  38. 38.
    Australian Institute of Health and Welfare (AIHW) (2011) End-stage kidney disease in Australia: total incidence, 2003–2007. AIHW, Canberra. Available at: http://www.aihw.gov.au
  39. 39.
    Smith JM, Ho PL, McDonald RA (2002) Renal transplant outcomes in adolescents: a report of the North American pediatric renal transplant cooperative study. Pediatr Transplant 6:493–499PubMedCrossRefGoogle Scholar
  40. 40.
    Gao X, Veale A, Serjeantson SW (1992) HLA class II diversity in Australian aborigines: unusual HLA-DRB1 alleles. Immunogenetics 36:333–337PubMedGoogle Scholar
  41. 41.
    Sparke C, Moon L, Green F, Mathew T, Cass A, Chadban S, Chapman J, Hoy W, McDonald S (2013) Estimating the total incidence of kidney failure in Australia including individuals who are not treated by dialysis or transplantation. Am J Kidney Dis 61:413–419PubMedCrossRefGoogle Scholar

Copyright information

© IPNA 2013

Authors and Affiliations

  • Blair S. Grace
    • 1
    • 2
  • Sean E. Kennedy
    • 3
    • 4
  • Philip A. Clayton
    • 1
    • 5
    • 6
  • Stephen P. McDonald
    • 1
    • 2
  1. 1.Australia and New Zealand Dialysis and Transplant Registry (ANZDATA)AdelaideAustralia
  2. 2.Discipline of MedicineUniversity of AdelaideAdelaideAustralia
  3. 3.Department of NephrologySydney Children’s HospitalRandwickAustralia
  4. 4.School of Women’s and Children’s HealthUniversity of New South WalesSydneyAustralia
  5. 5.Department of Renal MedicineRoyal Prince Alfred HospitalSydneyAustralia
  6. 6.Sydney Medical SchoolUniversity of SydneySydneyAustralia

Personalised recommendations