Racial differences in access to the kidney transplant waiting list for children and adolescents with end-stage renal disease

Context. Renal transplantation is the treatment of choice for pediatric pat ients with end-stage renal disease (ESRD). Black patients wait longer for k idney transplants than do white patients. Objective. To determine whether the increased time to transplantation for b lack pediatric patients is attributable not only to a shortage of suitable donor organs, but also to racial differences in the time from a child's fir st treatment for ESRD until activation on the cadaveric kidney transplant w aitlist. Design. National longitudinal cohort study. Setting. US Medicare-eligible, pediatric ESRD population. Patients. Children and adolescents less than or equal to 19 years old at th e time of their first dialysis for ESRD between 1988 and 1993, followed thr ough 1996. Patients who received living donor renal transplants were exclud ed from study. Main Outcome Measures. Time from first dialysis for ESRD until activation o n the kidney transplant waiting list, relative hazard of activation on the waiting list for black compared with white pediatric patients. Results. Comparisons of the time from first dialysis for ESRD to waitlistin g among the 2162 white (60.7%) and 1122 black (31.5%) patients studied usin g survival analysis revealed that blacks were less likely to be waitlisted at any given time in follow-up. In multivariate analysis, even after contro lling for patient age, gender, socioeconomic status, geographic region, inc ident year of renal failure, and cause of ESRD, blacks were 12% less likely to be waitlisted than were whites at any point in time (relative hazard: . 88: 95% confidence interval: .79-.97). Conclusions. Racial disparities in access to the renal transplant waiting l ist exist in pediatrics. Whether these disparities are attributable to diff erences in time of presentation to a nephrologist, physician bias in identi fication of transplant candidates, or patient preferences warrants further study.