Kidney Week

Abstract: SA-PO085

Racial Disparities in Access to Kidney Transplant: Medically (In)Appropriate?

Session Information

• Transplantation: Recipient and Donor Assessment
  October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Transplantation

• 1802 Transplantation: Clinical

Authors

• Ku, Elaine, University of California San Francisco, San Francisco, California, United States

Elaine Ku,

• Lee, Brian K., University of California San Francisco, San Francisco, California, United States

Brian K. Lee,

• McCulloch, Charles E., University of California San Francisco, San Francisco, California, United States

Charles E. McCulloch,

• Roll, Garrett R., University of California San Francisco, San Francisco, California, United States

Garrett R. Roll,

• Adey, Deborah B., University of California, San Francisco, San Francisco, California, United States

Deborah B. Adey,

• Johansen, Kirsten L., University of California, San Franicsco, San Francisco, California, United States

Kirsten L. Johansen,

Background

Racial and ethnic disparities are known to be present in kidney transplant access.Our objective was to understand whether differences in recipient medical eligibility contribute to these known disparities.

Methods

We included 1,573,786 adults who started dialysis between 1995-2015 according to the US Renal Data System.The exposure was race/ethnicity (non-Hispanic white [NHW], non-Hispanic black [NHB], or Hispanic). Outcomes were differences in medical eligibility for and time to kidney transplant after dialysis initiation. We used multivariable Cox models to examine the association between predictor and outcome. We then repeated our Cox models, excluding individuals who may be medically ineligible for transplant (e.g. age>70, malignancy, heart disease, and body mass index>35 kg/m²).

Results

During 4.1 years of mean follow-up, 129,820 patients received a transplant. NHBs and Hispanics had a lower prevalence of potential medical barriers [Figure 1] to transplant at time of dialysis initiation than NHWs. Overall, access to transplant was 56% lower in NHBs and 43% lower in Hispanics compared to NHWs [Figure 2A]. When we repeated our Cox models after excluding patients who may be medically ineligible for transplantation (70% of the population), these disparities widened in the remaining "very healthy" subcohort [Figure 2B].

Conclusion

NHBs and Hispanics had fewer medical contraindications but lower access to transplantation than NHWs. Differences in medical eligibility do not appear to explain racial/ethnic disparities in access to transplant, and in fact, may mask the magnitude of the inequities that are present. These findings are concerning, as the healthiest candidates appear to have the lowest access to transplant.

Funding

• NIDDK Support