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Kidney Week

Abstract: TH-PO1145

Accessibility and Graft Outcome According to Economic Inequality in South Korea: A Widening Gap After Expansion of Insurance Coverage

Session Information

Category: Transplantation

  • 1902 Transplantation: Clinical

Authors

  • Park, Sehoon, Seoul National University Hospital, Seoul, Korea (the Republic of)
  • Kim, Ji Eun, Seoul National University Hospital, Seoul, Korea (the Republic of)
  • Kim, Yong Chul, Seoul National University Hospital, Seoul, Korea (the Republic of)
  • Kim, Dong Ki, Seoul National University Hospital, Seoul, Korea (the Republic of)
  • Joo, Kwon Wook, Seoul National University Hospital, Seoul, Korea (the Republic of)
  • Kim, Yon Su, Seoul National University Hospital, Seoul, Korea (the Republic of)
  • Lee, Hajeong, Seoul National University Hospital, Seoul, Korea (the Republic of)
Background

Disparity in accessibility to and prognosis of kidney transplantation according to wealth inequality has been an important issue.

Methods

We performed a nationwide, population-based cohort study using the national claims database of Korea in which nationwide health insurance is provided. End-stage renal disease (ESRD) patients from 2007 to 2015 were included. As their wealth status was identifiable annually, the financial states were collected and stratified into five subgroups in each year. Time-trends of incidence proportion of kidney transplantation among ESRD patients in each year was initially assessed. The risk of graft failure was analyzed as prognostic outcome within the transplant recipients.

Results

Significant disparity in kidney transplantation accessibility was present and it was further widening, particularly from the year 2009 in which the national health insurance service started to cover desensitized kidney transplantation. Desensitized or preemptive transplantation was less common in the poorest group who were more frequently receiving transplantation after 5 years of dialysis in the recent periods. The prognosis of kidney transplantation was significantly worse in the poorer people, and this disparity also worsened during the study periods.

Conclusion

Prominent disparity regarding accessibility to and prognosis of kidney transplantation presented in Korea according to wealth inequality and was further worsening. Worsening pressure of donor shortage was less severe in the richer people who were preferentially benefited from the recent expansion of donor pool.