The Effect of Race on Access and Outcome in Transplantation

Kasiske, Bertram L.; Neylan, John F.; Riggio, Robert R.; Danovitch, Gabriel M.; Kahana, Lawrence; Alexander, Steven R.; White, Martin

doi:10.1056/nejm199101313240505

Cited by 208 publications

(90 citation statements)

References 28 publications

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“…[2][3][4][5]18,25,26 Black Americans have lower access to renal transplantation than white Americans, probably because of lower referral rates for transplantation assessment, which may themselves be due to physician attitudes about poor adherence and lower graft success rates among black patients. 17,22,27,28 Numerous studies from the United States also show inferior graft outcomes among black transplant recipients. Data from the United Network for Organ Sharing registry showed that between 1995 and 1999, the 5-yr graft survival rates for deceased donor transplants was 70 and 55%, respectively, for white and black patients.…”

Section: Discussionmentioning

confidence: 99%

“…In the United States, renal allograft survival is significantly lower in black than in white patients, [5][6][7][8][9][10] which might be due to higher immunologic risk, poorer medication adherence, or decreased access to pre-and posttransplantation care. 8,[11][12][13][14][15][16][17][18][19][20][21][22][23] Whether black Canadian transplant recipients also have decreased transplant survival is unclear because there are no published data describing transplant outcomes among this patient group. A recent study comparing outcomes in Canada and the United States demonstrated that American transplant recipients had an increased risk for mortality.…”

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confidence: 99%

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Similar Outcomes among Black and White Renal Allograft Recipients

Yeates¹,

Wiebe²,

Gill³

et al. 2009

Journal of the American Society of Nephrology

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Black renal transplant recipients experience shorter graft survival than white recipients, but no published data describe the graft outcomes among black Canadian recipients. Here, we analyzed data from the Canadian national renal replacement therapy registry, which included 20,243 incident dialysis patients (3% black, 97% white), 5036 of whom received a renal transplant during the study period. Black patients were significantly less likely to receive a renal transplant (deceased and living-donor combined) when compared with white patients (hazard ratio 0.59; 95% confidence interval 0.51 to 0.69; P Ͻ 0.0001). Among patients who underwent a renal transplant, there was no significant difference in the likelihood of graft failure between black and white patients, even after adjustment for comorbidities and socioeconomic status; black patients, however, had significantly lower posttransplantation mortality compared with white patients (hazard ratio 0.49; 95% confidence interval 0.28 to 0.88; P ϭ 0.02). In conclusion, graft outcomes between black and white Canadian renal transplant patients are similar. Because this differs from the experience reported from the United States, further direct comparisons between the two populations is warranted.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Similar Outcomes among Black and White Renal Allograft Recipients

Yeates¹,

Wiebe²,

Gill³

et al. 2009

Journal of the American Society of Nephrology

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“…17,18 Prior studies have also highlighted differences in the use of invasive procedures for ischemic heart disease by race. 4 A recent report on ethnic differences in the use of PD for ESRD in adults 2 revealed that black-white differences in initial PD use could not be explained by many demographic, socioeconomic, or co-morbid factors.…”

Section: Discussionmentioning

confidence: 99%

Racial Differences in Choice of Dialysis Modality for Children With End-stage Renal Disease

et al. 1997

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ABSTRACT. Objective. Black-white disparities in the use of specific medical and surgical services have been reported in adult populations. Such disparities are not well documented in children. We sought to determine whether racial disparities in the use of medical services exist among children with chronic illness who have similar health insurance, specifically the choice of dialysis modality for individuals with end-stage renal disease.Design. National cross-sectional study. Setting. Outpatient dialysis facilities throughout the United States.Patients and Participants. All Medicare-eligible children (age, 19 years) undergoing renal replacement therapy in 1990 in the United States, using data from the Medicare ESRD registry.Outcome Measures. The odds of receiving hemodialysis versus peritoneal dialysis according to race. Adjustment was made for differences in age, gender, cause, and duration of end-stage renal disease, income, education, and facility chracteristics using multiple logistic regression.Results. In 1990, 870 white and 368 black children received chronic (>1 year) renal replacement therapy in the United States. In bivariate analysis, blacks were two times (odds ratio [OR], 2.2; 95% confidence interval [CI], 1.7, 2.8) more likely than whites to receive hemodialysis versus peritoneal dialysis. After controlling for other patient and facility characteristics in multivariate analysis, black children were still significantly more likely than white children to receive hemodialysis (OR, 2.4; 95% CI, 1.7, 3.5).Conclusions. Black race is strongly associated with the use of hemodialysis in children. Family, patient, or provider preferences could account for the difference in choice of therapy by race. Pediatrics 1997;99(4). URL: http://www.pediatrics.org/cgi/content/full/99/4/e6; chronic renal failure, children; racial disparities, peritoneal dialysis, health insurance.ABBREVIATIONS. ESRD, end-stage renal disease; HD, hemodialysis; PD, peritoneal dialysis; RRT, renal replacement therapy.In 1990, the Council on Ethical and Judicial Affairs of the American Medical Association called for the elimination of racial disparities in medical treatment decisions in the United States.1 They urged physicians to examine their own practices and for the profession to "increase the awareness of racial disparities in medical treatment decisions through broad discussion of the issue."1 While black-white disparities in treatment options have been previously documented in adults, particularly in nephrology, 2,3 cardiology, 4 cardiac surgery, 5 obstetrics, 1 and general internal medicine, 6 this issue has not been explored fully in populations cared for by general or subspecialty pediatricians.7 Black-white disparities in use of medical services can be confounded by differences in health insurance status making this issue difficult to examine. One population in which primary health insurance differences do not exist is in end-stage renal disease (ESRD) patients covered by Medicare insurance.Recently, lower rates in initiation of p...

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“…28,29 Thus, most programs offer organs to patients infected with hepatitis C virus (HCV), patients with diabetes, older patients (up to a point), and black patients, despite clear evidence that post-transplantation survival is diminished in each of these groups. [30][31][32][33][34][35][36][37][38] On ethical grounds alone, there is no justification for providing organs to these groups of patients but not to patients infected with HIV.…”

Section: Ethical Considerationsmentioning

confidence: 99%