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Kidney Week

Abstract: PO2103

The Effect of Race Coefficients on Preemptive Listing for Kidney Transplantation

Session Information

Category: Transplantation

  • 1902 Transplantation: Clinical

Authors

  • Nair, Vinay, Northwell Health, New Hyde Park, New York, United States
  • Hirsch, Jamie S., Northwell Health, New Hyde Park, New York, United States
  • Jandovitz, Nicholas, Northwell Health, New Hyde Park, New York, United States
  • Jhaveri, Kenar D., Northwell Health, New Hyde Park, New York, United States
  • Molmenti, Ernesto P., Northwell Health, New Hyde Park, New York, United States
  • Abate, Mersema, Northwell Health, New Hyde Park, New York, United States
Background

Race coefficients of glomerular filtration rate estimation (eGFR) formulas may be partially responsible for racial inequality in preemptive listing for kidney transplantation. The objective was to determine whether differences in racial distribution of preemptively listed candidates are reduced by calculating eGFR irrespective of race.

Methods

The Scientific Registry of Transplant Recipients database was used to evaluate differences in racial distribution of preemptive listing before and after application of the MDRD and CKD-EPI race coefficients to all preemptively listed non-Black kidney transplant candidates (eGFR modulation). Non-Black patients who had a recalculated eGFR > 20 were removed from the preemptive group. Odds ratios of preemptive listing were calculated by race with Black as the reference before and after eGFR modulation. Variables known to influence preemptive listing were included in the multivariable model.

Results

Among 385,087 kidney-alone transplant candidates from January 1, 2010 to December 2, 2020, 118,329 (30.7%) were identified as preemptively listed (median [IQR] age 56 [45-64]; 57.7% male; 71.7% White, 19% Black, 7.8% Asian, 0.6% multi-racial, 0.6% Native American, 0.3% Pacific Islander). After eGFR modulation, non-Black patients with an eGFR ≥ 20ml/min were removed. Compared to Black candidates, the adjusted odds of preemptive listing for White candidates decreased from 2.01 (CI 1.78-2.26; p<0.001) before eGFR modulation to 1.18 (CI 1.0-1.39; p=0.046) with the MDRD and 1.37 (CI 1.18-1.58; p=0.001) with the CKD-EPI equations after adjusting for race coefficients.

Conclusion

The racial distribution of preemptively listed candidates closely mirrored the distribution on the wait list when all races were subject to the Black race coefficients. Removing race coefficients in GFR estimation formulas may result in more equitable racial distribution of preemptively listed candidates.