Racial disparities in quality of health are major issues affecting healthcare delivery. While substantial studies have been done in adults with end-stage renal disease (ESRD), similar studies are lacking in pediatric patients with ESRD, We retrospectively analyzed our transplant database from 1978-2002 to identify racial trends in a pediatric ESRD population. Significant racial differences were noted in number of preemptive transplants, type of graft received, height at transplant and causes of ESRD.