Racial Disparities in Access to and Outcomes of Kidney Transplantation in Children, Adolescents, and Young Adults: Results From the ESPN/ERA-EDTA (European Society of Pediatric Nephrology/European Renal Association-European Dialysis and Transplant Association) Registry.

BACKGROUND Racial disparities in kidney transplantation in children have been found in the United States, but have not been studied before in Europe. STUDY DESIGN Cohort study. SETTING & PARTICIPANTS Data were derived from the ESPN/ERA-EDTA Registry, an international pediatric renal registry collecting data from 36 European countries. This analysis included 1,134 young patients (aged ≤19 years) from 8 medium- to high-income countries who initiated renal replacement therapy (RRT) in 2006 to 2012. FACTOR Racial background. OUTCOMES & MEASUREMENTS Differences between racial groups in access to kidney transplantation, transplant survival, and overall survival on RRT were examined using Cox regression analysis while adjusting for age at RRT initiation, sex, and country of residence. RESULTS 868 (76.5%) patients were white; 59 (5.2%), black; 116 (10.2%), Asian; and 91 (8.0%), from other racial groups. After a median follow-up of 2.8 (range, 0.1-3.0) years, we found that black (HR, 0.49; 95% CI, 0.34-0.72) and Asian (HR, 0.54; 95% CI, 0.41-0.71) patients were less likely to receive a kidney transplant than white patients. These disparities persisted after adjustment for primary renal disease. Transplant survival rates were similar across racial groups. Asian patients had higher overall mortality risk on RRT compared with white patients (HR, 2.50; 95% CI, 1.14-5.49). Adjustment for primary kidney disease reduced the effect of Asian background, suggesting that part of the association may be explained by differences in the underlying kidney disease between racial groups. LIMITATIONS No data for socioeconomic status, blood group, and HLA profile. CONCLUSIONS We believe this is the first study examining racial differences in access to and outcomes of kidney transplantation in a large European population. We found important differences with less favorable outcomes for black and Asian patients. Further research is required to address the barriers to optimal treatment among racial minority groups.

50 Jahre Jewish Publication Society of America

Hans Lamm

Shakers : compendium of the origin, history, princicples, rules and regulations, government, and doctrines of the United Society of Believers in Christ's Second Appearing : with biographies of Ann Lee, William Lee, Jas. Whittaker, J. Hocknell, J. Meacham, and Lucy Wright

by F. W. Evans

(Appendix) Benthic foraminifera distribution of upper Creatceous and Paleocene at DSDP Hole 72-516F

Benthic foraminifers of the Coniacian-Santonian through the Paleocene were recovered from a continuous pelagic carbonate section from Hole 516F on the Rio Grande Rise. Sixty-five genera and 153 species have been identified, most of which have been reported from other localities. Bathyal depths are reflected in the benthic assemblages dominated by gavelinellids (Gavelinella beccariiformis, G. velascoensis), Nuttallides truempyi, and various gyroidinids and buliminids. Rapid subsidence during the Coniacian-Santonian from nearshore to upper to middle bathyal depths was followed by much reduced subsidence, with the Campanian-Paleocene interval accumulating at middle bathyal to lower bathyal depths. A census study based on detailed sampling reveals major changes in benthic faunal composition at the Cretaceous/Tertiary boundary transition. It was a time of rapid turnover, with the extinctions of numerous species and the introduction of many new species. Overall, species diversity decreases about 20%, and approximately one-third of latest Maestrichtian species do not survive to the end of the Cretaceous. This shift indicates a significant environmental change in the deep sea, the precise nature of which is not apparent from the foraminifers or their enclosing sediments.