Abstract: TH-PO1025
Care Delivery Phenotypes in Cardiovascular Preventive Care Among Kidney Transplant Recipients
Session Information
- Transplantation: Clinical - Outcomes, Malignancy, and Pathology
October 22, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2002 Transplantation: Clinical
Authors
- Long, Qian, Yale University, New Haven, Connecticut, United States
- Aponte Becerra, Laura, Yale University, New Haven, Connecticut, United States
- Berry, Shivankshi, Yale University, New Haven, Connecticut, United States
- Wilson, Francis Perry, Yale University, New Haven, Connecticut, United States
- Mansour, Sherry, Yale University, New Haven, Connecticut, United States
Background
Cardiovascular disease is the leading cause of death in kidney transplant recipients (KTRs) with a functioning graft, yet preventive care is inconsistent. Whether gaps reflect insufficient access or failures within encounters, and which subgroups are most affected, is unclear.
Methods
This is a retrospective cohort of 815 adult KTRs transplanted at a single academic center (2013 to 2020) with at least 1 year of follow-up. We constructed a composite CV preventive care delivery score (statin prescribing, LDL ≤100 mg/dL, HbA1c ≤7% in diabetics; proportion of applicable metrics achieved, range 0 to 1) and cross classified with KTRs by clinical visit frequency (transplant, primary care, nephrology, cardiology, endocrinology, other specialty) and delivery score, dichotomized at the cohort median (24 visits/yr; score 0.50).
Results
We identified 4 phenotypes within our cohort, which are Reference (high engagement, high care; N=204, 29%); Efficient (low engagement, high care; N=212, 30%); Access gap (low engagement, low care; N=136, 20%); Delivery gap (high engagement, low care; N=145, 21%). Despite similar comorbidity (median Elixhauser 3.0 in both), Delivery gap KTRs visited clinic over twice as often as Efficient (median 38 vs 14 visits/yr) yet achieved LDL ≤100 mg/dL in only 3% vs 63% and statin prescribing in 15% vs 86%. Females were 1.8 fold more likely than males to be in the Delivery gap phenotype (29% vs 16%, p<0.001). KTRs younger than 50 years were 1.7 fold more likely than older KTRs to be in Delivery gap (28% vs 17%, p<0.001). Delivery gap varied modestly by household income (25% in lowest tertile vs 19% in highest, p=0.02) but not by race or ethnicity.
Conclusion
Our findings identified a Delivery gap phenotype affecting 21% of KTRs, disproportionately affecting female and younger KTRs, with comorbidity equivalent to peers receiving effective care, receives more clinical contact than any other group yet experiences persistently inadequate care. These findings point to an intervention target where missed opportunities within encounters, not access alone, drive care failures.
Funding
- NIDDK Support