Abstract: FR-OR96
More than 16,000 Transplant Recipients and Previous Living Donors at Risk for Poor Access to Reproductive Health Care
Session Information
- Women's Health and Kidney Diseases: From Bench to Bedside
October 25, 2024 | Location: Room 24, Convention Center
Abstract Time: 05:20 PM - 05:30 PM
Category: Women's Health and Kidney Diseases
- 2200 Women's Health and Kidney Diseases
Authors
- Hendren, Elizabeth M., The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
- Av-Gay, Gal, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
- Kadatz, Matthew J., The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
- Gill, John S., The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
Background
It is imperative that kidney transplant recipients (KTR) and living kidney donors (LKD) have access to reproductive health care. Since the overturning of Roe v Wade in 2022, 14 states have banned abortion in all or almost all circumstances and 7 states have significantly restricted access (between 6-18 weeks). It is unknown how many KTR and LKD are affected by these policies.
Methods
We characterized the demographics of female KTR and LKD 18-45 years old in the United States as of May 1, 2024 from the OPTN dataset. Because policies are frequently changing, patients were stratified into 3 categories based on their home state policy for abortion as of May 1, 2024. P-values are calculated from Wilcoxon rank sum tests for continuous variables and Fisher's exact tests for categorical variables.
Results
Overall 9,001/21,673 KTR (41%) and 7,476/18,988 LKD (39%) live in states with either a total or partial restriction on abortion. KTR who live in areas with less access to reproductive care were also more likely to have additional risk factors for pregnancy complication including Black race, high BMI, and diabetes as a cause of kidney failure and were less likely to have received a living donor transplant (Table 1).
Conclusion
A significant proportion of KTR and LKD live in areas with decreased access to reproductive health care. Medical comorbidities and demographic risk factors can exacerbate the pre-existing pregnancy risk. These findings quantify the magnitude of the health challenge created by recent changes in state policies and may be useful in planning for alternative strategies and advocacy efforts to ensure KTR and past LKD receive access to essential reproductive health care.
Demographics of Female KTR by abortion access in home state
| Abortion Banned (1) n=5,333 (24.6%) | Limited Abortion Access (2) n=3,688 (17%) | Legal Access to Abortion n=12,652 (58.4%) | p-value | |
| Recipient Current Age Mean (SD) | 36.4 (30.5 - 41.3) | 36.8 (30.7 - 41.4) | 36.6 (30.9 - 41.3) | 0.31 |
| Recipient Race n (%) | Black 1,683 (31.6%) White 1,980 (37.1%) Other 1,670 (31.3%) | Black 1,362 (36.9%) White 1,280 (34.7%) Other 1,046 (28.4%) | Black 2,656 (21.0%) White 4,985 (39.4%) Other 5,011 (39.6%) | < 0.0001 |
| Recipient BMI Mean (SD) | 26.4 (±7.1) | 25.9 (±6.5) | 25.3 (±6.6) | < 0.0001 |
| Insurance N (%) | Private 1,843 (34.6%) Public 3,456 (64.8%) | Private 1,262 (34.2%) Public 2,411 (65.4%) | Private 5,131 (40.6%) Public 7,462 (59.0%) | < 0.0001 |
| Diabetes as cause of ESRD N (%) | 531 (10.0%) | 290 (7.9%) | 949 (7.5%) | <0.0001 |
| Transplant Vintage (years) Mean (SD) | 8.1 (±5.3) | 7.8 (±5.4) | 8.5 (±5.5) | < 0.0001 |
| Transplant from Living Kidney Donor N (%) | 1,885 (35.3%) | 1,240 (33.6%) | 5,625 (44.5%) | < 0.0001 |
1. States where abortion is illegal in all or most circumstances AL, AR, ID, IN, KY, LA, MS, MO, ND, OK, SD, TN, TX, WV 2. States with restrictions on abortion (6-18 weeks) AZ, FL, GA, NE, NC, SC, UT