Abstract: TH-PO872
Disparities in Access to Kidney Transplantation for Asian, Hispanic, and Black Candidates
Session Information
- Transplantation: Donation and Access
November 02, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2102 Transplantation: Clinical
Authors
- Clark-Cutaia, Maya N., New York University Rory Meyers College of Nursing, New York, New York, United States
- Menon, Gayathri, New York University Grossman School of Medicine, New York, New York, United States
- Li, Yiting, New York University Grossman School of Medicine, New York, New York, United States
- Kim, Byoungjun, New York University Grossman School of Medicine, New York, New York, United States
- Wall, Stephen P., New York University Grossman School of Medicine, New York, New York, United States
- Hladek, Melissa D., Johns Hopkins University School of Nursing, Baltimore, Maryland, United States
- Purnell, Tanjala S., Johns Hopkins University Center for Teaching and Learning, Baltimore, Maryland, United States
- Segev, Dorry L., New York University Grossman School of Medicine, New York, New York, United States
- McAdams-DeMarco, Mara, New York University Grossman School of Medicine, New York, New York, United States
Background
Disparities in access to kidney transplantation (KT) for minoritized end-stage kidney disease (ESKD) patients are persistent and pervasive. The distinct points along the KT continuum where disparities are most prominent are poorly understood, however their identification is crucial for developing targeted interventions. We quantified disparities from ESKD diagnosis to listing and first KT for Asian, Hispanic, and Black candidates, compared to White candidates.
Methods
Engaging USRDS data, we identified 2,200,356 adults with initial ESKD diagnosis between 1999-2019. We used Fine and Gray sub-distribution hazards models, adjusted for age, sex, race/ethnicity, comorbidities, primary health insurance, to determine adjusted sub-hazards ratio (aSHR) of listing after ESKD diagnosis, and KT after listing, with death as a competing risk. We tested the proportional hazards assumption using complementary log-log plots and Schoenfeld residuals.
Results
White candidates were more likely to be waitlisted and transplanted than candidates of other racial/ethnic groups. Waitlisted White candidates were also more likely to receive KT, especially LDKTs (Black aSHR (95% confidence interval (CI)): 0.33 (0.32-0.35); Hispanic aSHR (95%CI): 0.66 (0.64-0.69); Asian aSHR (95%CI): 0.45 (0.42-0.47)) and pre-emptive KTs (Black aSHR (95%CI): 0.53 (0.47-0.60); Hispanic aSHR (95%CI): 0.65 (0.56-0.75); Asian aSHR (95%CI): 0.47 (0.38-0.58).
Conclusion
The field of transplantation should engage communities to identify interpersonal, community, and societal barriers to access to KT among minoritized candidates.
Funding
- Private Foundation Support