DENVER – Black children who receive kidney transplants appear more likely to lose their transplants sooner, compared with whites, results from a large analysis showed.
In addition, black pediatric patients living in high poverty neighborhoods face a more than twofold risk of transplant failure, compared with white patients.
Dr. Sandra Amaral
"It has been reported that kidney transplants in blacks do not last as long as in whites, but we don’t really understand why this happens," Dr. Sandra Amaral said during a press briefing at the annual meeting of the American Society of Nephrology. "We think part of it is biologic; there are genetic differences between races, differences in diseases, and differences in our immune systems. But we also think that there may be socioeconomic differences. Based on our clinical practice, what we see is that if you’re poor it’s harder to get to your [medical] appointments. It may be harder to pay for your medicines. You may live in a household with a single care provider who’s really struggling to just feed you, much less make sure that your medicines are given on time every single day."
Dr. Amaral of the department of pediatrics at Emory University, Atlanta, and her associates studied 5,024 patients from the United States Renal Data System (USRDS) under age 21 years who received a kidney transplant between 2000 and 2006. The researchers followed the patients for transplant outcomes through September 2008 and linked their residential zip codes with poverty data from the 2000 United States Census.
Dr. Amaral reported that 18.3% of the patients experienced organ rejection during a mean follow-up of 3.6 years. Black patients were 2.3 times more likely than were white, non-Hispanic patients to experience organ rejection. In addition, Hispanic white patients were 24% less likely to experience organ rejection, compared with non-Hispanic white patients (hazard ratio = 0.76).
After the researchers adjusted for demographic, clinical, and socioeconomic factors, the researchers found that blacks were more likely to experience organ rejection, compared with non-Hispanic whites, and the degree of disparity varied by patient’s residential neighborhood.
Poverty also played a role in adverse outcomes in all patients. However, black patients fared worse. For example, black patients from neighborhoods in which more than 25% of residents lived below the federal poverty line were 2.46 times more likely to experience organ rejection, compared with their white counterparts. This relationship was also apparent in the wealthiest neighborhoods (those in which fewer than 5% lived below the federal poverty line), where black patients were 40% more likely to experience organ rejection at any given time during the follow-up, compared with non-Hispanic whites.
"It looks like poverty does make a difference," Dr. Amaral said. "It makes it harder for you to have a successful transplant."
She acknowledged certain limitations of the study, including the fact that the USRDS is unable to capture the specific barriers that get in the way of better transplant survival. "Is it because patients can’t pay for their medications, or is it because they can’t get to their appointments?" she asked. "Are there other things that get in the way of them being successful? This is an area for further study."
Dr. Amaral said that she had no relevant financial disclosures.