Adan Z Becerra1,2, Kevin E Chan3, Paul W Eggers3, Jenna Norton3, Paul L Kimmel3, Ivonne H Schulman3, Susan R Mendley4. 1. Department of Public Health Sciences, Social and Scientific Systems, Silver Spring, Maryland. 2. Department of Surgery, Rush University Medical Center, Chicago, Illinois. 3. National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland. 4. National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland susan.mendley@nih.gov.
Abstract
BACKGROUND: The role of kidney transplantation in differential survival in Black and White patients with childhood-onset kidney failure is unexplored. METHODS: We analyzed 30-year cohort data of children beginning RRT before 18 years of age between January 1980 and December 2017 (n=28,337) in the US Renal Data System. Cox regression identified transplant factors associated with survival by race. The survival mediational g-formula estimated the excess mortality among Black patients that could be eliminated if an intervention equalized their time with a transplant to that of White patients. RESULTS: Black children comprised 24% of the cohort and their crude 30-year survival was 39% compared with 57% for White children (log rank P<0.001). Black children had 45% higher risk of death (adjusted hazard ratio [aHR], 1.45; 95% confidence interval [95% CI], 1.36 to 1.54), 31% lower incidence of first transplant (aHR, 0.69; 95% CI, 0.67 to 0.72), and 39% lower incidence of second transplant (aHR, 0.61; 95% CI, 0.57 to 0.65). Children and young adults are likely to require multiple transplants, yet even after their first transplant, Black patients had 11% fewer total transplants (adjusted incidence rate ratio [aIRR], 0.89; 95% CI, 0.86 to 0.92). In Black patients, grafts failed earlier after first and second transplants. Overall, Black patients spent 24% less of their RRT time with a transplant than did White patients (aIRR, 0.76; 95% CI, 0.74 to 0.78). Transplantation compared with dialysis strongly protected against death (aHR, 0.28; 95% CI, 0.16 to 0.48) by time-varying analysis. Mediation analyses estimated that equalizing transplant duration could prevent 35% (P<0.001) of excess deaths in Black patients. CONCLUSIONS: Equalizing time with a functioning transplant for Black patients may equalize survival of childhood-onset ESKD with White patients.
BACKGROUND: The role of kidney transplantation in differential survival in Black and White patients with childhood-onset kidney failure is unexplored. METHODS: We analyzed 30-year cohort data of children beginning RRT before 18 years of age between January 1980 and December 2017 (n=28,337) in the US Renal Data System. Cox regression identified transplant factors associated with survival by race. The survival mediational g-formula estimated the excess mortality among Black patients that could be eliminated if an intervention equalized their time with a transplant to that of White patients. RESULTS: Black children comprised 24% of the cohort and their crude 30-year survival was 39% compared with 57% for White children (log rank P<0.001). Black children had 45% higher risk of death (adjusted hazard ratio [aHR], 1.45; 95% confidence interval [95% CI], 1.36 to 1.54), 31% lower incidence of first transplant (aHR, 0.69; 95% CI, 0.67 to 0.72), and 39% lower incidence of second transplant (aHR, 0.61; 95% CI, 0.57 to 0.65). Children and young adults are likely to require multiple transplants, yet even after their first transplant, Black patients had 11% fewer total transplants (adjusted incidence rate ratio [aIRR], 0.89; 95% CI, 0.86 to 0.92). In Black patients, grafts failed earlier after first and second transplants. Overall, Black patients spent 24% less of their RRT time with a transplant than did White patients (aIRR, 0.76; 95% CI, 0.74 to 0.78). Transplantation compared with dialysis strongly protected against death (aHR, 0.28; 95% CI, 0.16 to 0.48) by time-varying analysis. Mediation analyses estimated that equalizing transplant duration could prevent 35% (P<0.001) of excess deaths in Black patients. CONCLUSIONS: Equalizing time with a functioning transplant for Black patients may equalize survival of childhood-onset ESKD with White patients.
Authors: Anna Francis; David W Johnson; Anette Melk; Bethany J Foster; Katrina Blazek; Jonathan C Craig; Germaine Wong Journal: Clin J Am Soc Nephrol Date: 2020-02-19 Impact factor: 8.237
Authors: Salina P Waddy; Allen J Solomon; Adan Z Becerra; Julia B Ward; Kevin E Chan; Chyng-Wen Fwu; Jenna M Norton; Paul W Eggers; Kevin C Abbott; Paul L Kimmel Journal: J Am Soc Nephrol Date: 2020-02-20 Impact factor: 10.121
Authors: Kyle R Jackson; Mary G Bowring; Amber Kernodle; Brian Boyarsky; Niraj Desai; Olga Charnaya; Jacqueline Garonzik-Wang; Allan B Massie; Dorry L Segev Journal: Am J Transplant Date: 2020-02-21 Impact factor: 8.086
Authors: Ajay K Israni; Nicholas Salkowski; Sally Gustafson; Jon J Snyder; John J Friedewald; Richard N Formica; Xinyue Wang; Eugene Shteyn; Wida Cherikh; Darren Stewart; Ciara J Samana; Adrine Chung; Allyson Hart; Bertram L Kasiske Journal: J Am Soc Nephrol Date: 2014-05-15 Impact factor: 10.121