Body: Black and Hispanic children with end-stage renal disesase (ESRD) experience longer waiting times for deceased donor kidney transplantation. However, prior studies have not examined whether these disparities in transplant access persist after adjustment for differences in organ availability at the organ procurement organization (OPO) level.

Methods and Results: We used national data from the Scientific Registry of Transplant Recipients to examine racial variation in time from waitlisting to receipt of deceased donor kidney for all children < 18 years from 2005-2010 (n=3943). Hispanic children had longer waiting times compared to children from other racial and ethnic groups (334 days (95% CI: 296-367) versus 279 days (95% CI: 233-308) for African-Americans and 250 days (95% CI: 226-282) for Caucasian children). In unadjusted analyses and in a multivariable Cox regression model that adjusted only for individual characteristics (age, gender, insurance, disease etiology), Hispanics had a 10% lower probability of transplant (HR 0.90, HR 0.038). However, waiting time for Hispanic children varied greatly across OPOs.

With further adjustment for OPO level characteristics through the use of a multivariate frailty model, Hispanics no longer had reduced probability of transplant vs. whites (HR 1.03, p 0.585). We observed that Hispanics living in OPOs with longer overall waiting times had equally long wait times compared with white children.

Conclusions: Previously observed longer waiting times for Hispanic vs. white children with ESRD may be partially explained by the finding that Hispanic children tend to live in OPOs with longer waiting times for kidney transplant. Future studies to reduce racial disparities in pediatric waiting times for deceased donor kidneys may need to closely consider geographic disparities. National sharing of kidneys for children may be one approach to reach racial parity in access to transpalnt.

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