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Kidney Week

Abstract: SA-PO978

Racial Disparities in Access to Deceased Donor Kidney Transplantation in the United States, 1999-2023

Session Information

Category: Transplantation

  • 2102 Transplantation: Clinical

Authors

  • Al Ammary, Fawaz, University of California Irvine, Irvine, California, United States
  • Lentine, Krista L., Saint Louis University, St Louis, Missouri, United States
  • Crews, Deidra C., Johns Hopkins University, Baltimore, Maryland, United States
  • Muzaale, Abimereki, Johns Hopkins University, Baltimore, Maryland, United States
  • Adeyemo, Simeon, University of California Irvine, Irvine, California, United States

Group or Team Name

  • Living Donor Transplant Outcome Collaborative (LDTOC).
Background

The Kidney Allocation System was revised in December 2014 to provide priority from start of dialysis rather than listing date to improve equity in access to transplantation. We examined the interplay between race/ethnicity and duration of dialysis in access to deceased donor kidney transplantation over time.

Methods

We used the Scientific Registry of Transplant Recipients of 350,516 adult first-time kidney transplant candidates on dialysis between 1999 and 2018. Outcome was dialysis time to deceased donor kidney transplantation, and exposure was race/ethnicity. We used competing risk survival to estimate the cumulative incidence of the outcome competing with death and multivariable Cox regression models to adjust for confounders. Analyses stratified by era (1999–2003, 2004–2008, 2009–2013, and 2014–2018). Patients were followed for 5 years, ending in December 2023.

Results

Overall, the cumulative incidence of deceased donor kidney transplantation for patients on dialysis varied by race [Figure]. In adjusted models compared to White patients, in the eras 1999–2003, 2004–2008, 2009–2013 , and 2014–2018, Black patients were less likely to be transplanted by 45%, 37%, 35%, and 27%; Hispanic patients by 45%, 50%, 43%, and 38%; and Asian patients by 42%, 37%, 31%, and 30%, respectively [Table].

Conclusion

Although there has been increase in deceased donor kidney transplantation in recent years for U.S. dialysis patients, racial disparities remain. Gaps are narrowing for Black and Asian patients but remain unchanged for Hispanic patients on dialysis. Programs are needed to address systemic barriers and enhance policies to support equitable access to transplantation for racial minorities.

Funding

  • NIDDK Support