Abstract 1958 Health Services Research: Access, Organization, Policy Platform, Tuesday, 5/4

Renal transplantation (tx) is the treatment of choice for pediatric pts with end stage renal disease (ESRD). Racial disparities in waiting time for tx have previously been attributed to greater difficulty in finding HLA matched kidneys for black pts from a largely white organ donor pool. To determine whether the increased time to tx for black pediatric pts is due, not only to a shortage of suitable donor organs, but to racial differences in activating pediatric pts on the tx waitlist, we conducted a national longitudinal cohort study of pediatric pts (≤19yrs) with onset of ESRD 1988 - 1993, followed through 1996. Pt demographic & clinical data from the U.S. Renal Data System were linked with wait list data from the United Network for Organ Sharing. Pts who received living donor (LD) renal tx were excluded race on time from ESRD onset to 1st wait list date for renal tx, after controlling for sociodemographic factors and assigned cause of ESRD.

From 1988 through 1993, there were 5448 pts ≤ 19 yrs with new onset ESRD. 1889 (35%) who received LD renal tx in follow-up were excluded from study. Of 3559 pts remaining, 2250 (63%) were wait listed and 2006 (56%) received a cadaveric tx by Dec, 1996. 60.7% of pts were white, 31.5% were black. Blacks were older when they presented with ESRD, median age 16.9 yrs vs. 14.8 yrs for whites. Black pts were more likely to have focal & segmental glomerular sclerosis causing ESRD (p=.001), and to reside in zipcodes with lower median household incomes (p=.001).

Comparisons of time from ESRD onset to waitlist using survival analysis revealed that blacks were less likely to be waitlisted at any given time in follow-up (p=.007, log-rank). 56% & 67% of whites were waitlisted by 2 and 5 yrs after onset compared to 50% & 64% of black pts at 2 and 5 yrs respectively. In multivariate analysis, even after controlling for pt age, gender, median household income and primary cause of ESRD, blacks were almost 20% less likely to be waitlisted than whites over time (RR 0.85, 95% CI 0.78 - 0.94). We conclude that racial disparities in access to renal tx for children and adolescents cannot be solely attributed to differences in the availability of suitable organs, as differences in access to the waitlist exist by race. Further studies to determine whether these disparities are due to socioeconomic differences, clinical factors or patient preferences unmeasured in this analysis are warranted.