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Abstract: PO2506

Ethnic Disparities in Hospitalization After Deceased Donor Kidney Transplantation

Session Information

Category: Transplantation

  • 1902 Transplantation: Clinical

Authors

  • Islam, Shahidul, Division of Health Services Research, Department of Foundations of Medicine, NYU Long Island School of Medicine, Mineola, New York, United States
  • Mohan, Sumit, Division of Nephrology, Department of Medicine, Columbia University College of Physicians & Surgeons, New York, New York, United States
  • Brown, William Mark, Department of Internal Medicine, Section on Nephrology, Wake Forest School of Medicine, Winston-Salem, North Carolina, United States
  • Pastan, Stephen O., Renal Division, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, United States
  • Israni, Ajay K., Division of Nephrology, Department of Medicine, Hennepin County Medical Center, University of Minnesota, Minneapolis, Minnesota, United States
  • Gaston, Robert S., Division of Nephrology, Department of Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, United States
  • Mena- Gutierrez, Alejandra, Department of Internal Medicine, Section on Nephrology, Wake Forest School of Medicine, Winston-Salem, North Carolina, United States
  • Reeves-Daniel, Amber M., Department of Internal Medicine, Section on Nephrology, Wake Forest School of Medicine, Winston-Salem, North Carolina, United States
  • Julian, Bruce A., Division of Nephrology, Department of Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, United States
  • Freedman, Barry I., Department of Internal Medicine, Section on Nephrology, Wake Forest School of Medicine, Winston-Salem, North Carolina, United States
  • Divers, Jasmin, Division of Health Services Research, Department of Foundations of Medicine, NYU Long Island School of Medicine, Mineola, New York, United States
Background

African American (AA) recipients of deceased-donor (DD) kidney transplants have shorter allograft survival than recipients of other racial/ethnic groups. However, it remains unclear whether similar patterns are observed for healthcare utilization. Hospitalization rates (HR) for recipients of kidneys from 2,639 AA and 12,043 European American (EA) DDs who had one kidney transplanted into an AA and one into an EA recipient were analyzed. Four donor/recipient pairs (DRP) were studied: AA/AA, AA/EA, EA/AA and EA/EA using data from the Scientific Registry of Transplant Recipients for transplantations performed between January 1, 2001 and June 30, 2016.

Methods

All reported hospitalizations for the duration of the kidney allograft were counted. Negative binomial models were fitted to compare post-transplant HRs with adjustment for transplant era (2001-2005, 2005-2010 and post 2010), the kidney donor risk index (KDRI), estimated post-transplant survival (EPTS), donor- and recipient age and sex, recipient insurance, prior employment status, delayed graft function (DGF) and cold ischemia time.

Results

HRs were higher among recipients of kidneys from AA DDs 419.0 (390.4, 449.7) for AA/AA and 412.7 (379.8, 448.5) for AA/EA, compared to 362.8 (350.1, 375.9) for EA/AA and 331.9 (319.9, 344.3) per 1000 person-years for EA/EA DRPs. The adjusted HR was 67.9% (56.7%, 79.9%) higher for transplantations performed after 2005, compared to those performed during 2001-2005. HRs were also higher for recipients with Medicaid insurance 62.0% (16.4%, 125.5%), or DGF 25.9% (18.7%, 33.5%), but lower for employed recipients, -18.9% (-23.5%, -14.0%). These rates increased by 40.6% (28.4%, 53.8%) for a unit increase in the EPTS and by 24.6% (10.9%, 39.9%) for a unit increase in KDRI. Higher rates were observed among recipients of AA DD kidneys, independently of recipient race/ethnicity 19.2% (11.2%, 27.9%).

Conclusion

HRs among the DRPs have increased over time with higher rates among recipients of AA DD kidneys. Additional donor-level factors may contribute to the hospitalization rate after DD kidney transplantation.

Funding

  • NIDDK Support