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Abstract: SA-PO806

Variations in Access to Repeat Transplantation by Transplant Center Continuity

Session Information

Category: Transplantation

  • 2002 Transplantation: Clinical

Authors

  • Emanuels, Davidson F., University of California San Francisco School of Medicine, San Francisco, California, United States
  • Copeland, Timothy P., University of California San Francisco, Department of Epidemiology and Biostatistics, San Francisco, California, United States
  • Johansen, Kirsten L., Hennepin Healthcare, Minneapolis, Minnesota, United States
  • Mcculloch, Charles E., University of California San Francisco, Department of Epidemiology and Biostatistics, San Francisco, California, United States
  • Ku, Elaine, University of California San Francisco Medical Center at Parnassus, San Francisco, California, United States
Background

In the U.S., there is significant fragmentation in the care of patients with a failing kidney transplant. Our objective was to examine the association between transplant center continuity and access to repeat transplantation.

Methods

Using US Renal Data System data, we studied adults relisted for kidney transplantation between 2006-2016. We examined whether transplant center continuity (same versus different transplant center where relisting occurred) was associated with time to a second kidney transplant or odds of preemptive relisting using cause-specific and logistic regression models, respectively. We tested for effect modification by race/ethnicity.

Results

Among 21,154 patients, 29% switched transplant centers, 31% were preemptively relisted, and 48% received a second transplant during median follow-up of 2.9 years. Patients who switched centers had a 9% lower hazard of repeat transplantation, particularly from a deceased donor source (Figure 1). Patients who switched centers had 29% lower odds of preemptive relisting compared to those who remained at the same center (OR 0.71; 95% CI 0.66-0.77). This finding was modified by race/ethnicity (interaction p<0.001), with non-Hispanic Black (OR 0.52; 95% CI 0.45-0.61) and Hispanic (OR 0.59; 95% CI 0.47-0.73) patients who switched centers having disproportionately lower odds of preemptive relisting compared with non-Hispanic White patients (OR 0.81; 95% CI 0.74-0.89, Figure 2).

Conclusion

Individuals who remained at the same transplant center had better access to preemptive relisting and retransplantation. Black and Hispanic candidates who switched centers were especially disadvantaged. Additional studies on the role of continuity of care are needed to improve outcomes.

Funding

  • NIDDK Support