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Kidney Week

Abstract: SU-OR42

Exploration of Racial Disparities in the Kidney Transplant Process Among Dialysis Patients

Session Information

Category: Transplantation

  • 1902 Transplantation: Clinical

Authors

  • Brunelli, Steven M., Davita Clinical Research, Minneapolis, Minnesota, United States
  • Hunt, Abigail, Davita Clinical Research, Minneapolis, Minnesota, United States
  • Colson, Carey, Davita Clinical Research, Minneapolis, Minnesota, United States
  • Tentori, Francesca, Davita Clinical Research, Minneapolis, Minnesota, United States
Background

Kidney transplant is generally considered the best long-term treatment for dialysis patients. Before receiving a transplant, a patient must be referred to a transplant center, undergo extensive clinical evaluation, and then be placed on a wait list. Previous studies have observed that black patients are less likely to receive kidney transplants than white patients. However, it is unclear at which points in the transplant process inequity is imparted. In this analysis, we used a single source of data to compare the entire transplant process among black and white patients at a large dialysis organization (LDO).

Methods

Eligible patients were those who, between Jul 2015-Jun 2018, were 18-80 years old; were incident to dialysis and began care at the LDO within 30 days of first ever dialysis; and had not undergone a transplant evaluation or listing prior to dialysis start. Exposure was ascribed based on race as documented in LDO medical records (black or white). Patients were followed forward in time from study entry until 31 Mar 2019 or censoring or loss to follow-up. Transplant referrals, listings, and receipts were compared across exposure categories using time-to-event models adjusted for demographics, comorbidities, biochemistries, and socioeconomic factors

Results

We identified 60,229 eligible incident patients (23,499 black; 36,730 white). Compared to whites, black patients were 23% more likely to be referred for transplant (hazard ratio [HR] and 95% confidence interval [CI] = 1.23 [1.20, 1.27]). Among referred patients, black patients were 19% less likely to be placed on a wait list than whites (HR [95% CI] = 0.81 [0.77, 0.86]). Among wait-listed patients, black patients were 52% less likely to receive a transplant than whites (HR [95% CI] = 0.48 [0.41, 0.56]). Overall, black patients were only 46% as likely to receive transplants as white patients (HR [95% CI] = 0.46 [0.39, 0.53]).

Conclusion

These results support prior findings that racial disparities exist within the kidney transplant process and indicate that these disparities occur downstream of the referral.