Abstract: TH-PO879
Disparities in Phase Progression in Kidney Transplant Evaluation
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
- Ramakrishnan, Adarsh, New York-Presbyterian Columbia University Medical Center, New York, New York, United States
- Husain, Syed Ali, New York-Presbyterian Columbia University Medical Center, New York, New York, United States
- King, Kristen L., New York-Presbyterian Columbia University Medical Center, New York, New York, United States
- Yu, Miko, New York-Presbyterian Columbia University Medical Center, New York, New York, United States
- Tsapepas, Demetra, New York-Presbyterian Columbia University Medical Center, New York, New York, United States
- Mohan, Sumit, New York-Presbyterian Columbia University Medical Center, New York, New York, United States
Group or Team Name
- Columbia University Renal Epidemiology (CURE).
Background
Inequity in access to kidney transplantation by race/ethnicity is a significant challenge. In this study, we evaluate the association between race and progression to subsequent phases of transplant in patients being evaluated for a kidney transplant.
Methods
We conducted a retrospective cohort study of patients undergoing kidney transplant evaluation at our center from 2020-2023. Using time-to-event analyses, we examined the time to reaching the next phase of transplant by self-identified patient racial group. Patients determined to be ineligible for listing were censored at committee review date while remaining patients were censored at the end of the study period. We then created a multivariate Cox proportional hazards model to assess the association between race and phase progression while controlling for age, gender, employment status, cause of end-stage renal disease, and insurance type.
Results
We identified 957 patients who were evaluated for kidney transplant with a documented race. Of these, 9% were Asian, 28% were Black/African American, 29% were Hispanic/Latino and 35% were White. Median progression time from evaluation to listing was 181 days and listing to transplant was 264 days. The unadjusted probability of progressing from evaluation to listing was significantly different between all four racial groups (p<0.0001), but there was no difference in progressing from listing to transplant (p=0.12) (Figure). In adjusted models, Black/African American patients had 37% lower rate of progressing from evaluation to listing (p=0.0001) and 35% lower rate of progressing from listing to transplant (p=0.01) compared to White patients, and Hispanic/Latino patients had 34% lower rate of progressing from evaluation to listing (p=0.0005) compared to White patients.
Conclusion
Disparities in progression from evaluation to waitlisting contribute to racial disparities in kidney transplant access.
Figure: Kaplan-Meier failure curves displaying progression from evaluation to listing and listing to transplant, stratified by race