Association between ethnicity and kidney transplant waitlist outcomes beyond estimated post‐transplant survival score

Abstract

White kidney transplant candidates have the highest pre-transplant mortality rate compared to other ethnicities. The reason for a higher mortality rate is not well-understood. Estimated post-transplant survival (EPTS) score has been used to predict patient survival after transplant and may be associated with pre-transplant survival. First-time kidney transplant candidates listed between 2015 and 2018 were identified from the Organ Procurement Transplantation Network database. Individuals listed for multiple organs, at multiple centers, and age <18 years were excluded. We examined the impact of ethnicity on waitlist mortality and delisting. A total of 114 806 candidates were included. The study population was categorized into four groups which were 43% white, 28% Black, 19.2% Hispanic, and 9.8% "other ethnicities." At 5.2 years, the cumulative incidences of death and delist were 32%, 31%, 29%, and 26%, respectively. Compared to whites, adjusted subdistribution hazard ratio (aSHR) for death and delist among Black, Hispanics, and "other ethnicities" were 0.92 (95% CI 0.89-0.95), 0.89 (95% CI 0.85-0.91), and 0.76 (95% CI 0.72-0.80) after adjustment by EPTS along with other factors, respectively. After adjusting for EPTS score along with additional confounding factors and functional status at initial listing, white ethnicity was independently associated with an increased risk for death and delist.

Quantifying the Effect of Consent for High–Kidney Donor Profile Index Deceased Donor Transplants in the United States

“…While the survival benefit of high-KDPI transplants extends to Black and Hispanic patients, there is not a higher risk of mortality on the waiting list for these patient populations relative to White patients. 7,17,18 Thus, further understanding of the reason for the differences in high-KDPI consent by race/ethnicity is important to evaluate prospectively. Patients with longer prelisting dialysis time (>72 months) had lower likelihood of high-KDPI consent.…”

Favorable outcomes in Hispanic recipients receiving simultaneous pancreas kidney transplantation

“…2 While the incidence of ESRD from DM is 1.5-fold higher in Hispanics than in non-Hispanic whites, Hispanics often have delayed access to kidney transplants and SPKT compared to whites. [15][16][17][18][19] This is due to multiple reasons, including lack of private insurance, residing in a lowincome area, lower education, cultural beliefs, and unemployment. 19 Despite delayed access to transplants, the proportion of Hispanics receiving SPKT has increased from 7% to 15% over time.…”