Background: Among the various options of renal replacement therapy (RRT), preemptive transplantation (pTx) is the modality of choice in children. The objective of this study was to examine racial and ethnic disparities in access to pTx and assess the effect of the new Kidney Allocation System (KAS) on these disparities in children and young adults with End Stage Renal Disease (ESRD).

Methods: A retrospective cross-sectional study of patients 0-20 years, using United States Renal Data System from 10/1/2005-06/1/2016 was done. We examined the odds of receiving pTx for black and Hispanic vs. white patients after adjusting for age, sex, socioeconomic status (SES), Organ Procurement Organization region and access to pre-ESRD nephrology care. We assessed the evolution of the odds of pTx pre-KAS (before December 4, 2014) and after introduction of KAS (on or after December 2014) using logistic regression.

Results: Among 13,199 patients initiating RRT, 45% were white, 26% black, and 29% Hispanic. There were 11,728 patients receiving ESRD care pre-KAS and 1,471 post-KAS. Pre-KAS, blacks and Hispanics were less likely than whites to have pTx (black OR.19 [0.16-0.22]; Hispanic OR 0.36 [0.32-0.41]) when compared to hemodialysis. Post KAS, blacks and Hispanics remained less likely to have pTx (black OR 0.20 [0.17-0.23]; Hispanic OR 0.34[0.23-0.50]). Adjusting for demographic, clinical, and SES differences, attenuated the effect of race/ethnicity pre-KAS, among Hispanics (OR 0.70 [0.59-0.84]) but not among blacks (0.32 [0.26-0.39]). No change in the effect of race on access to pTx was found post-KAS (blacks OR 0.24 [0.16-0.36]; Hispanics OR 0.67 [0.39-1.15]).

Conclusion: The probability of pTx was 68% lower pre- KAS and worsened to 76% lower post-KAS for blacks vs. whites. New KAS has been shown to reduce racial disparities in access to kidney transplantation in children but was associated with a decrease in rate of living donation especially among blacks. This could explain the reduced probability of pTx post-KAS. Further studies are needed to explore the causes for worsening of disparities in pTx in blacks since the introduction of KAS.

CITATION INFORMATION: George R., Basu M., Garro R., Hogan J., Patzer R. Racial and Ethnic Disparities in Preemptive Transplantation before and after the Introduction of Kidney Allocation System, in Pediatric and Young Adult End Stage Renal Disease Patients Am J Transplant. 2017;17 (suppl 3).

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