An overview of disparities and interventions in pediatric kidney transplantation worldwide

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 will examine the most current findings regarding disparities in pediatric kidney transplantation and consider interventions which may help reduce those disparities.

Living Donor Kidney Transplantation

“…Although we recognize that there are other noteworthy trends in LKD (e.g., substantial increase in unrelated living donors), we focused our review of the literature and workgroup discussions on LDKT and LKD trends related to race and ethnicity, income, age, sex, and geography. This article is not intended to be a comprehensive summary of LDKT disparities and LKD differences, because others have provided exceptional reviews of this literature (4,9,(13)(14)(15). Rather, our intention here is to provide a sufficient backdrop to frame the workgroup's discussions and recommendations.…”

“…Different patterns of racial and ethnic disparities in kidney transplantation suggest that some minorities, relative to non-Hispanic white patients, may experience more kidney transplant access barriers, be more likely to have initiated dialysis at the time of transplant referral, wait longer for a deceased donor transplant, have higher mortality rates on the waiting list, and have less optimal transplant outcomes (4,6,(13)(14)(15)(16)(17)(18)(19). Because the proportion of patients on the kidney transplant waiting list is increasing for racial/ethnic minorities (while declining for nonHispanic whites) (1), the extreme shortage of deceased donor kidneys is likely to exacerbate these transplant disparities in the years ahead.…”

Inequalities in access to pediatric ESRD care: a global health challenge

“…Indigenous children are less likely to receive a preemptive or a living-donor transplant in Australia [35], non-Western European origin is associated with reduced access to transplant in Belgium and the Netherlands [36], and ethnic minorities have lower rates of preemptive transplantation in the UK [37]. The reasons for these inequalities, including any contribution from underlying inequities, are subject to ongoing research [38].…”

“…These include country-or region-level factors (availability of RRT facilities and pediatric transplant programs), center-level factors (specialized pediatric nephrology services, education about transplant, referral, listing, acceptance of a deceased donor, or identification of a living donor), and patient-level factors (age, ethnicity, co-morbidities, residence location, socio-economic, educational, and cultural issues) [38][39][40][41].…”

“…However, this may only be achievable in the long run. In high-income countries, possible interventions which may help to improve access to transplantation have been previously discussed in this journal [38].…”