Abstract: SA-PO087
Renal Transplantation: Does Race Play a Role?
Session Information
- Transplantation: Recipient and Donor Assessment
October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 1802 Transplantation: Clinical
Authors
- Suliman, Sarah T., University of Florida College of Medicine Jacksonville, Jacksonville, Florida, United States
- Carlson, Jeremy, University of Florida College of Medicine Jacksonville, Jacksonville, Florida, United States
- Smotherman, Carmen, University of Florida College of Medicine Jacksonville, Jacksonville, Florida, United States
- Gautam, Shiva, University of Florida College of Medicine Jacksonville, Jacksonville, Florida, United States
- Ilic, Ljubomir M., University of Florida College of Medicine Jacksonville, Jacksonville, Florida, United States
Background
Multiple studies have revealed discrepancy in healthcare access and outcomes in certain racial populations. We present a retrospective cohort study of end stage renal disease (ESRD) patients from our institution scrutinizing whether or not race is a factor in the referral process for renal transplantation.
Methods
The study population included all of the adult 200 ESRD patients who are currently receiving hemodialysis at the outpatient dialysis unit at the University of Florida (UF) Health in Jacksonville from January 2016 to February 2018. We divided race into 3 categories: Blacks, Whites, and Others, which consisted mostly of Hispanic patients together with other races/ethnicities. Outcomes were categorized as the patients who refused referral, who were not referred for transplant, and who were referred for transplant. We also collected established factors in the transplant evaluation process such as age, Hemoglobin A1c ≥ 7, Body mass index ≥ 40, left ventricular ejection fraction ≤ 40, presence of coronary or peripheral arterial disease (PAD/CAD), albumin level < 3.5, and cancer, cirrhosis and smoking history. All data were collected using chart review and analyzed using univariate analyses and multinomial logistic regression. Associations between the race and outcome categories are presented as adjusted Odds Ratios (OR) with 95% confidence interval (CI) using the not-referred group as the reference category. The study was approved by the UF IRB committee.
Results
In the univariate analysis, age, PAD/CAD, and albumin level were found to be potential confounders and were included in the final model. Blacks (OR=16.0, 95%CI 3.3-77.2, p=0.018) and Whites (OR=22.5, 95%CI 3.4-149.8, p=0.013) were more likely to be referred for transplant than not compared to Others. The odds of transplant refusal versus a non-referral in Blacks and Whites were not different from Others (p=0.270, and p=0.171, respectively).
Conclusion
In our nephrology practice, Blacks and Whites were more frequently referred for renal transplant than other ethnicities/races. There was no difference between the races in transplant refusal, which might point to satisfactory education and communication across the race groups. At this point we speculate the lack of funding and immigration status might play a role in the observed differences. Future studies are needed to address these possibilities.