Fewer pre-emptive renal transplantations and more rejections in immigrant children compared to native Dutch and Belgian children

Abstract

Immigrant children receive fewer pre-emptive and living donor transplantations compared to native children. After transplantation, immigrant children are at higher risk for acute rejection irrespective of the mode of transplantation.

An overview of disparities and interventions in pediatric kidney transplantation worldwide

“…[14] Data from the Netherlands and Belgium demonstrate that the median time to first transplantation after initiation of dialysis in pediatric patients who received a DDKT was 26 months in immigrant children as opposed to 18 months in native children. [7] These disparities mirror findings in the adult literature. [29] Differences in wait time have been largely attributed to differential distribution of HLA genotypes in populations of different racial and ethnic backgrounds.…”

“…[3] Further, there exist pervasive racial and ethnic disparities in kidney transplantation in both the adult and pediatric setting. [4–7] While much of the research examining this issue has been conducted in the United States, similar disparities have been identified in Australia[8], Belgium[7], Canada[9] the Netherlands[7], South Africa[10], and the United Kingdom[11] among others, indicating the global nature of this issue. Although it is important to note that some of these disparities may be the result of factors that are beyond the control of the medical system (e.g., co-morbidities and hereditary diseases that are associated with certain ethnic groups), [12, 13] studies have repeatedly demonstrated that differences in medical factors alone are not sufficient to explain the disparities in transplantation in their entirety.…”

“…Between 2007 and 2011 in Belgium and the Netherlands, 59% of native children received LDKT, as opposed to 24% of immigrant children. [7] In Australia, among those patients who did not receive pre-emptive transplantation, 38% of white children received LDKT, in comparison to only 23% of indigenous children. [8] Unfortunately, there have been very few studies in the pediatric population to identify the underlying cause of these disparities beyond population level analysis.…”

“…There are clear disparities in post-transplant outcomes as well[7, 10, 17, 41]. A 2007 analysis of the over 6287 pediatric patients who had been registered in the NAPRTCS database demonstrated that 5-year graft survival rates for AA children were significantly lower than for white children (65.6% versus 83.1%).…”

“…[10] Disparities in the rates of acute rejection in the post-transplant setting have been described in the Netherlands and Belgium. [7] In addition to being at increased risk for poor graft outcomes, other studies have demonstrated AA pediatric patients are at increased risk of other health disparities in the post-transplant setting, including increased rates of hypertension. [42]…”