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Abstract: TH-PO738

Impact of Insurance Type on Kidney Transplant Wait-List Status and Post-Transplant Outcomes in the United States

Session Information

Category: Diversity and Equity in Kidney Health

  • 800 Diversity and Equity in Kidney Health


  • Morenz, Anna Marie, University of Washington Department of Medicine, Seattle, Washington, United States
  • Perkins, James D., Clinical and Bio-Analytics Transplant Laboratory, University of Washington, Seattle, Washington, United States
  • Dick, Andre, Seattle Children's Hospital, Seattle, Washington, United States
  • Ng, Yue-Harn, University of Washington Division of Nephrology, Seattle, Washington, United States

Insurance type has been associated with lower access to kidney transplant (KT) and worse KT outcomes. In this study, we assessed if insurance type remains a risk marker for worse KT outcomes post Affordable Care Act and Kidney Allocation System.


We conducted a retrospective analysis of the Organ Procurement and Transplantation Network data from 12/14 to 6/21. We used competing risk analyses to study the association of private versus public (Medicare, Medicaid, or government-sponsored) insurance on wait-list status and post-transplant outcomes, controlling for candidate, donor and transplant variables.


Table 1 depicts baseline characteristics and wait-list status by insurance type. KT candidates with public insurance were significicantly more likely to die/become too sick for KT or receive a DDKT, but less likely to receive a living donor KT (LDKT). As shown in Figure 1, after KT, recipients with public insurance had higher mortality but comparable allograft survival.


Publicly insured KT candidates are at higher risk wait-list removal, have lower probability of LDKT, and higher probability of dying post-KT. Factors contributing to these disparities need to be addressed in future studies to achieve equity in KT.


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