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Kidney Week

Abstract: FR-PO799

Assessment of Disparities in Access to Valganciclovir Cytomegalovirus Prophylaxis in High-Risk African American Kidney Transplant Patients

Session Information

Category: Diversity and Equity in Kidney Health

  • 900 Diversity and Equity in Kidney Health

Authors

  • Bethi, Shipra Reddy, Medical University of South Carolina College of Medicine, Charleston, South Carolina, United States
  • Andrade, Erika, Medical University of South Carolina College of Medicine, Charleston, South Carolina, United States
  • Mesmar, Zaid Mohammed Azzam, Jordan University of Science and Technology, Irbid, Jordan
  • Taber, David J., Medical University of South Carolina Department of Surgery, Charleston, South Carolina, United States
Background

While access and outcomes disparities in African American (AA) kidney transplant recipients are well-known, there are limited studies assessing medication access disparities in transplant medicine. Cytomegalovirus (CMV) is a common viral infection that can cause serious complications in transplant recipients, with potential excess burden in AA communities. The high out-of-pocket costs associated with valganciclovir prophylactic therapy likely affect its use, so research is needed to fully understand differences in access to antiviral CMV prophylaxis and its impacts on CMV infection in AA transplant recipients.

Methods

This was a single-center, retrospective longitudinal cohort study in high-risk (CMV serostatus D+/R-) adult kidney recipients transplanted between 6/1/2010 and 5/31/2020, representing a 10-year cohort. Data was collected through electronic and manual medical record abstraction. Standard univariate comparative statistics were utilized in conjunction with binary logistic regression for multivariable modeling.

Results

418 kidney transplant recipients were included, of which 179 (42.8%) were AA and 239 were non-AA. Baseline demographics were significantly different in mean age in years (46.5 ± 12.9 AA vs. 50.9 ± 13.9 non-AA, p=0.001) and private and Medicaid insurance status (p<0.001). AAs experienced higher rates of death-censored graft loss (10.6% AA vs. 5.0% non-AA, p=0.031). There was no difference in CMV infection rate, opportunistic infection rate, leukopenia incidence, or death between AA and non-AA patients. AA patients were 42% less likely to receive valganciclovir assistance in covering out-of-pocket costs (assistance programs and/or fundraising/savings use) compared to non-AA patients (OR 0.58, 95% CI [0.379-0.892], p=0.013). In a multivariable model including age, Medicaid status, and donor marginality variables, the impact of AA race on use of these assistance programs was no longer statistically significant (OR 0.70, 95% CI [0.448-1.094], p=0.118).

Conclusion

In univariate analyses AAs were significantly less likely to utilize assistance programs or fundraising/savings to access valganciclovir, which was somewhat explained by age, insurance status, and donor type. Despite this, CMV infection rates did not differ significantly between the AA and non-AA cohorts.