Abstract: TH-PO1143
Longer Distance from Dialysis Facility to Transplant Center Is Associated with Lower Access to Transplantation
Session Information
- Transplantation: Clinical - Pretransplant Management
November 07, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 1902 Transplantation: Clinical
Authors
- Whelan, Adrian, University of California, San Francisco, California, United States
- Johansen, Kirsten L., Hennepin Healthcare, Minneapolis, Minnesota, United States
- Adey, Deborah B., University of California, San Francisco, California, United States
- Roll, Garrett R., University of California, San Francisco, California, United States
- Siyahian, Salpi, University of California, San Francisco, California, United States
- Ku, Elaine, University of California, San Francisco, California, United States
Background
The distance between patients’ residence and their kidney transplant center is not associated with access to transplantation. However, distance from the dialysis facility to the transplant center (DFTC distance) may be important for access to transplantation, as dialysis providers closer to the transplant center may maintain better communication with the transplant center and expedite patient work-up. We hypothesized that longer DFTC distance would associate with longer time to transplantation.
Methods
We included adults who started dialysis between 2005-2015 according to the US Renal Data System. The primary predictor was DFTC distance ≥100 miles vs. <100 miles (reference group). Outcome was time from dialysis initiation to kidney transplantation. We used adjusted Cox models and tested for interactions by region of the US, calendar year, and dialysis modality.
Results
172,995 patients were included; mean age was 51.6 yrs; 30.3% were black. DFTC distance varied by region of the US (table). Overall, DFTC distance ≥100 miles (vs. <100 miles) was associated with lower access to transplantation regardless of dialysis treatment modality, (table), but the association was modified by region of the US and calendar year (p <0.05 for interaction). Longer DFTC distance was associated with lower access especially among patients living in the South and West. The association between DFTC distance and access to transplantation has attenuated over time (table).
Conclusion
Longer DFTC distance was associated with lower access to kidney transplantation even after accounting for distance between patients and the transplant center. Our data suggest that system-level factors such as proximity between referring and transplant providers may contribute to access to transplantation, but this association varies across the US.
Funding
- Veterans Affairs Support