Racial Disparities Falling in Pediatric Kidney Transplant According to Emory Study

April 2012

A new Emory study shows that Share 35, a policy enacted by the United Network for Organ Sharing (UNOS) in 2005, may have been instrumental in decreasing wait times and improving the quality of donors for children with end stage renal disease (ESRD) over the past few years. The study was e-published on April 26 ahead of print publication in the Journal of the American Society of Nephrology.

Study authors were Drs. Rachel Patzer, assistant professor in the division of transplantation of the Department of Surgery and an Emory Transplant Center (ETC) epidemiologist; Nancy Kutner, professor of rehabilitation medicine; and William McClellan, professor of renal medicine and epidemiology, who was senior author. Sandra Amaral, a pediatric nephrologist who has since left Emory for the Children's Hospital of Philadelphia, was the first author on the paper.

"Share 35 gives preference to offers of deceased donor kidneys younger than age 35 to pediatric patients who need transplants to improve the quality of their lives," says Dr. Patzer. "While a living donation provides a child with the best quality organ and chances of graft survival, a deceased donor transplant can save a life. Before Share 35, black and Hispanic children with ESRD were less likely than white children to receive a deceased donor kidney transplant."

To determine whether Share 35 improved access to kidney transplantation for minority children, the Emory investigators analyzed data from the U.S. Renal Data System before and after the policy was put into place. Among 4,766 pediatric patients with incident ESRD, the probability of receiving a deceased donor kidney transplant increased 46% after Share 35, with Hispanics experiencing the greatest improvements (an increase of 81% for Hispanics, 45% for blacks, and 37% for whites). The findings showed a decrease in the average wait time before a deceased donor transplant, with Hispanics receiving one 201 days earlier, blacks 90 days earlier, and whites 63 days earlier.

"Share 35 has reduced racial disparities in access to deceased donor kidney transplants for children with end-stage kidney disease," Dr. Patzer continues. "This is a step toward improving access to transplantation for all children." However, the researchers found a cause for concern. Since 2005, there has been a shift from living to deceased donor sources for all races, with a 25% rate reduction in available living donors for white patients compared with 48% and 46% reductions for Hispanics and blacks, respectively.

"Additional studies are needed to explore these changes and determine how they may impact long-term graft survival," she says.