Abstract: TH-PO977

Defining the Delays to Kidney Transplant among American Indian Patients with Kidney Disease

Session Information

Category: Transplantation

  • 1702 Transplantation: Clinical and Translational

Authors

  • Keddis, Mira T., Mayo Clinic, Phoenix, Arizona, United States
  • Ilyas, Muneeb, Mayo Clinic, Phoenix, Arizona, United States
  • Zhang, Nan, Mayo Clinic Arizona, Scottsdale, Arizona, United States
  • Heilman, Raymond L., None, Phoenix, Arizona, United States
  • Sharma, Amit, Mayo Clinic, Phoenix, Arizona, United States
Background

The purpose of this study is to examine differences in the time from kidney transplant (KTx) evaluation to wait-listing and KTx rates in a cohort of American Indian (AI) patients compared to whites from 2012 to 2016 at a single center.

Methods

All AI patients presenting for KTx evaluation at Mayo Clinic Arizona from 2012 to 2016 were included (n=300). A random sample of non-Hispanic white controls matched for year of KTx evaluation was included (n=300).

Results

Compared to white controls, AI patients were younger (mean age 53±12.2 vs 57.2±13.4 years, p=0.0001), more likely to have diabetes (79 vs 41%, p<0.0001) and diabetic kidney disease (66.3 vs 35.7%, p<0.0001) and require dialysis at the time of evaluation (88 vs 58.3%, p<0.0001). They were more likely to have limited functional capacity at the time of KTx evaluation compared to white controls (55.3 vs 26.6%, p<0.0001). Several socioeconomic variables differed between the two groups with AI patients more likely to have the following associations: less than high school education (24.9 vs 7.3%, p<0.0001), single or widowed (32.6 vs. 17.8, p=0.008), and unemployed (81.7 vs 68.7%, p=0.001), There was no difference in the rate of prior history of cardiovascular disease between the two groups. AI patients had significantly lower rates of cancer diagnoses compared to white controls (3.3 vs 20.1%, p<0.0001). The time from initial KTx evaluation to selection conference decision regarding candidacy was delayed by 38 days for AI patients (mean 83 vs 45 days, p=0.0001) and they were more likely to be denied KTx compared to white controls (28.7 vs 19.2%, p=0.04). Reasons for denial did not differ between the two groups. Among patients deemed acceptable for KTx, AI patients were less likely to be listed on UNOS (84.2 vs 92.1 %, p=0.019), experienced longer delays from the time of approval for KTx to UNOS listing (median 42 vs 16 days, p<0.0001), and had longer waiting time from UNOS listing to receiving KTx (median 499 vs 380, p<0.0001) compared to whites. Transplant rates were significantly lower among AI compared to whites (25.5 vs 62%, p<0.0001).

Conclusion

Our study confirms that AI patients presenting for KTx suffer from significant delays in all steps of KTx evaluation and KTx rates in current times and highlights several clinical and socio-economic differences that may explain this disparity.