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Kidney Week

Abstract: PO2152

Lack of Insurance Predicts with Follow-up Deficiencies After Living Kidney Donation

Session Information

Category: Transplantation

  • 1902 Transplantation: Clinical

Authors

  • Lentine, Krista L., Saint Louis University, Saint Louis, Missouri, United States
  • Lam, Ngan, University of Calgary, Calgary, Alberta, Canada
  • Muiru, Anthony N., University of California San Francisco, San Francisco, California, United States
  • Tietjen, Andrea, RWJBarnabas Health, West Orange, New Jersey, United States
  • Xiao, Huiling, Saint Louis University, Saint Louis, Missouri, United States
  • Thomas, Christie P., The University of Iowa Hospitals and Clinics Department of Pathology, Iowa City, Iowa, United States
  • Mcnatt, Gwen Elise, The University of Iowa Hospitals and Clinics Department of Pathology, Iowa City, Iowa, United States
  • Garg, Amit X., Western University, London, Ontario, Canada
  • Sarabu, Nagaraju, University Hospitals Cleveland Medical Center Department of Orthopaedics, Cleveland, Ohio, United States
  • Kasiske, Bertram L., Hennepin Healthcare, Minneapolis, Minnesota, United States
Background

Follow-up after living kidney donation in the United States has improved with recent policy mandates. We hypothesized that lack of insurance at donation may be a barrier to postdonation follow-up.

Methods

We examined Scientific Registry of Transplant Recipients (SRTR) data for 90.460 living kidney donors (LKD) in 2004-2018 to examine associations (adjusted odds ratio, aOR) of insurance status and other baseline factors with clinical and laboratory follow-up after donation.

Results

Follow-up increased over time, and was especially high in older LKD. Follow-up was lower in uninsured compared to insured LKD over time, including in the era of the Affordable Care Act (Fig. A). In 2018, for uninsured vs insured LKD, respectively, clinical follow-up was 87.5% vs 90.4% at 6-months, and 76% vs 86.7% at 12-months, while 12-month lab follow-up was 55.4% vs 68.4%.
In multivariate regression including adjustment for donation year and other baseline factors, uninsured status was associated with 7% lower odds of 6-month clinical follow-up (aOR, 0.93) and 14% lower odd of lab follow-up (aOR, 0.86). Follow-up was also significantly (P<0.05) lower for LKD who were African American (aOR 0.85) or Hispanic (aOR 0.91), unrelated to their recipient (aOR 0.85), not working (aOR 0.81) and with less than college education (Fig. B).

Conclusion

While follow-up after living kidney donation is improving, uninsured LKD and those who are non-white, unemployed, and with lower education are less likely to receive follow-up. Novel initiatives are needed to provide access to follow-up care for at-risk LKD, including the uninsured and under-insured, to minimize the risk of socioeconomic disparities in long-term postdonation outcomes.

Funding

  • Other U.S. Government Support