Effects of patient compliance, parental education and race on nephrologists' recommendations for kidney transplantation in children

Transplantation is the treatment goal for youth with kidney failure. To assess the effects of compliance, parental education and race on nephrologists' recommendations for transplantation in children, we surveyed a national random sample of adult and pediatric nephrologists. We elicited transplant recommendations for case vignettes created from random combinations of patient age, gender, race, cause of renal failure, family structure, parental education and compliance. Of 519 eligible physicians, 316 (61%) responded. Nephrologists were more likely to recommend transplantation for children of college-educated parents than children of parents who did not finish high school, despite identical clinical and demographic characteristics (adjusted OR 1.48, 95% Cl 1.18,1.86). Patient noncompliance negatively influenced transplant recommendations (adjusted OR 0.1, 95% Cl 0.08, 0.13). Additionally, compliance had a different effect on transplant recommendations for white compared with black patients. The adjusted OR of a white, compliant patient being referred for transplantation were twice that of a black compliant patient (OR 2.06, 95% Cl 1.17,3.6). Education and compliance with therapy independently influence nephrologists' recommendations for transplantation in youth with kidney failure. Among the most compliant candidates, referral for transplantation may vary with patient race.