Contribution of Estimates of Glomerular Filtration to the Extensive Disparities in Preemptive Listing for Kidney Transplant

King, Kristen L.; Yu, Miko; Husain, S. Ali; Patzer, Rachel E.; Sandra, Vanessa; Reese, Peter P.; Schold, Jesse D.; Mohan, Sumit

doi:10.1016/j.ekir.2022.12.021

Cited by 3 publications

(7 citation statements)

References 30 publications

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“…This study builds upon the growing body of research highlighting persistent racial and ethnic disparities in the likelihood of receiving both LDKT and preemptive KT [16,17,29,[46][47][48][49][50][51][52]. Specifically, our findings underscore the role of residence in a deprived neighborhood, as well as the potential socioeconomic characteristics of these neighborhoods, driving decreased likelihood of both LDKT and preemptive KT.…”

Section: Discussionmentioning

confidence: 69%

“…Among the 10 deprivation components of the NDI (Table S1), we identified those most salient for the likelihood of receiving LDKT and preemptive KT [16,23]. We employed the same population weights from ACS to identify ZIP code-level deprivation components for each candidate.…”

Section: Neighborhood Deprivation Index (Ndi) and Deprivation Componentsmentioning

confidence: 99%

“…Collectively, these factors contribute to neighborhood deprivation [16,17,[21][22][23][24][25][26], reflecting the socioeconomic disadvantages within a given area [27]. While prior research has highlighted individuallevel barriers to LDKT and preemptive KT [16,17,23,28,29], a critical gap remains in understanding and quantifying the role of residential neighborhood deprivation and its individual components on a candidate's likelihood of receiving LDKT and preemptive KT.…”

Section: Introductionmentioning

confidence: 99%

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Components of Residential Neighborhood Deprivation and Their Impact on the Likelihood of Live‐Donor and Preemptive Kidney Transplantation

Li,

Menon,

Kim

et al. 2024

Clinical Transplantation

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IntroductionAdults residing in deprived neighborhoods face various socioeconomic stressors, hindering their likelihood of receiving live‐donor kidney transplantation (LDKT) and preemptive kidney transplantation (KT). We quantified the association between residential neighborhood deprivation index (NDI) and the likelihood of LDKT/preemptive KT, testing for a differential impact by race and ethnicity.MethodsWe studied 403 937 adults (age ≥ 18) KT candidates (national transplant registry; 2006–2021). NDI and its 10 components were averaged at the ZIP‐code level. Cause‐specific hazards models were used to quantify the adjusted hazard ratio (aHR) of LDKT and preemptive KT across tertiles of NDI and its 10 components.ResultsCandidates residing in high‐deprivation neighborhoods were more likely to be female (40.1% vs. 36.2%) and Black (41.9% vs. 17.7%), and were less likely to receive both LDKT (aHR = 0.66, 95% confidence interval [CI]: 0.64–0.67) and preemptive KT (aHR = 0.60, 95% CI: 0.59–0.62) than those in low‐deprivation neighborhoods. These associations differedby race and ethnicity (Black: aHRLDKT = 0.58, 95% CI: 0.55–0.62; aHRpreemptive KT = 0.68, 95% CI: 0.63–0.73; Pinteractions: LDKT < 0.001; Preemptive KT = 0.002). All deprivation components were associated with the likelihood of both LDKT and preemptive KT (except median home value): for example, higher median household income (LDKT: aHR = 1.08, 95% CI: 1.07–1.09; Preemptive KT: aHR = 1.10, 95% CI: 1.08–1.11) and educational attainments (≥high school [LDKT: aHR = 1.17, 95% CI: 1.15–1.18; Preemptive KT: aHR = 1.23, 95% CI: 1.21–1.25]).ConclusionResidence in socioeconomically deprived neighborhoods is associated with a lower likelihood of LDKT and preemptive KT, differentially impacting minority candidates. Identifying and understanding which neighborhood‐level socioeconomic status contributes to these racial disparities can be instrumental in tailoring interventions to achieve health equity in LDKT and preemptive KT.

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Section: Discussionmentioning

confidence: 69%

Section: Neighborhood Deprivation Index (Ndi) and Deprivation Componentsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Components of Residential Neighborhood Deprivation and Their Impact on the Likelihood of Live‐Donor and Preemptive Kidney Transplantation

Li,

Menon,

Kim

et al. 2024

Clinical Transplantation

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“…

Preemptive transplantation represents the ideal timing for providing a kidney transplant for patients, but the recent National Academies of Sciences, Engineering, and Medicine report recommended the elimination of preemptive deceased donor kidney transplantation because of concerns about equity. [1][2][3] Although there are compelling policy arguments to continue to encourage preemptive education, counseling, and preemptive listing, there are also economic and ethical questions about whether it is appropriate to allocate organs to preemptively waitlisted individuals when we have thousands of patients who are already treated with dialysis, especially given that preemptively listed patients tend to be socioeconomically and demographically advantaged. 4 By contrast, preemptive candidates represent a unique patient population who may be able to avoid the challenges of delayed graft function and oftentimes are seen as individuals who would be able to accept organs that might

…”

mentioning

confidence: 99%

“…Although we have seen a dramatic growth in preemptive waitlisting, group 1 preemptive deceased donor kidney transplants have remained relatively flat at approximately 1%–2% of all transplants. 3 The most rapid growth has been seen in the use of hard-to-place kidneys for preemptively listed candidates (Supplemental Figure 3) ( i.e ., in organs that were turned down on behalf of multiple candidates on dialysis), raising questions about the current narrative that preemptive transplants are taking kidneys away from patients on dialysis. Although we have previously drawn attention to the potentially detrimental consequences of eliminating preemptive waitlisting, our findings would suggest that the complete elimination of preemptive transplantation with deceased donor kidneys may not be necessary and may have a detrimental effect on organ utilization—in particular for individuals who are prioritized in allocation policy such as former donors and pediatric patients.…”

mentioning

confidence: 99%

Allocation and Utilization Patterns of Deceased Donor Kidneys for Preemptive Transplantation in the United States

King,

Yu,

Huml

et al. 2024

JASN

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Push toward pre-emptive kidney transplantation – for sure?

Cseprekal,

Jacquelinet,

Massy

2024

Clinical Kidney Journal

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Preemptive kidney transplantation (PKT) has long been considered the optimal treatment for patients with end-stage chronic kidney disease (CKD) seeking the most favorable long-term outcomes. However, the significant growth in transplant procedures over recent decades has led to a notable increase in waitlisted patients and a disproportionate demand for donor organs. This situation necessitates a reevaluation of transplantation timing and the establishment of rational indications from both societal and clinical perspectives. An increasing number of retrospective analyses have challenged the universal benefit of PKT, suggesting that premature indications for living or deceased donor PKT may not always yield superior hard outcomes compared to non-PKT approaches. Conventional predictive models have shown limitations in accurately assessing risks for certain subpopulations, potentially leading to significant disparities among waitlisted patients. To address these challenges, we propose the following considerations. Prediction models should not only optimize the distribution of our limited donor resources but also illuminate foreseeable risks associated with a potentially ‘unsuccessful’ PKT. Therefore, our paper seeks to underscore the necessity for further discourse on the smoldering concept of when and for whom living or deceased donor PKT should be considered. Is it universally beneficial, or should the clinical paradigm be reevaluated? In the endeavor to attain superior post-PKT survival outcomes compared to non-PKT or conservative treatment, it seems critical to acknowledge that other treatments may provide more favorable results for certain individuals. This introduces the intricate task of effectively navigating the complexities associated with ‘too early’ or ‘unsuccessful’ PKT.

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Contribution of Estimates of Glomerular Filtration to the Extensive Disparities in Preemptive Listing for Kidney Transplant

Cited by 3 publications

References 30 publications

Components of Residential Neighborhood Deprivation and Their Impact on the Likelihood of Live‐Donor and Preemptive Kidney Transplantation

Components of Residential Neighborhood Deprivation and Their Impact on the Likelihood of Live‐Donor and Preemptive Kidney Transplantation

Allocation and Utilization Patterns of Deceased Donor Kidneys for Preemptive Transplantation in the United States

Push toward pre-emptive kidney transplantation – for sure?

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