Abstract: FR-PO0963
Living-Donor Kidney Transplantation by Insurance Coverage over Two Decades
Session Information
- Transplantation: Clinical - Pretransplantation, Living Donation, and Policies
November 07, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2102 Transplantation: Clinical
Authors
- Al Ammary, Fawaz, University of California Irvine, Irvine, California, United States
- Kalantar-Zadeh, Kamyar, Harbor-UCLA Medical Center, Torrance, California, United States
- Rhee, Connie, University of California Los Angeles, Los Angeles, California, United States
- Bunnapradist, Suphamai, University of California Los Angeles, Los Angeles, California, United States
- Flores, Glenda M, University of California Irvine, Irvine, California, United States
- Lincoln, Karen D, University of California Irvine, Irvine, California, United States
- Adeyemo, Simeon, University of California Irvine, Irvine, California, United States
Background
Living donor kidney transplantation (LDKT) offers superior survival compared to both dialysis and deceased donor transplantation. However, LDKT is lacking and may be influenced by socioeconomic factors, including patient insurance coverage. We aimed to understand the association between insurance status and LDKT over the past 20 years to inform policy and strategies to increase LDKT.
Methods
We conducted a retrospective cohort study of 400,896 adult (aged ≥18 years) first-time kidney transplant candidates waitlisted in the U.S. between January 1, 2007, and December 31, 2022, using data from the Scientific Registry of Transplant Recipients (SRTR), with follow-up through December 31, 2024. The exposure of interest was insurance type (Private, Medicaid, or Medicare). The primary outcome was the receipt of LDKT within two years of waitlisting. We used competing risk models to estimate adjusted subdistribution hazard ratios (aSHRs), stratified by four-year eras: 2007–2010, 2011–2014, 2015–2018, and 2019–2022.
Results
Insurance coverage at waitlisting was as follows: Private (50%), Medicaid (15%), and Medicare (35%). Across all eras, candidates with Medicaid or Medicare were significantly less likely to receive LDKT compared to those with Private insurance. In the most recent era (2019–2022), the aSHR for LDKT was 0.46 (95% CI, 0.43–0.49) for Medicaid and 0.62 (95% CI, 0.59–0.64) for Medicare, relative to Private insurance.
Conclusion
These findings reveal significant disparities in access to LDKT by insurance coverage over the past two decades. Targeted programs and policies are needed to understand and address barriers to LDKT among patients with non-private insurance.
Funding
- NIDDK Support