Evolving Trends in Racial Disparities for Peri-Operative Outcomes with the New Kidney Allocation System (KAS) Implementation

Sánchez, Daisy Figueredo; DuBay, Derek A.; Prabhakar, Baliga; Taber, David J.

doi:10.1007/s40615-018-0464-3

Cited by 8 publications

(11 citation statements)

References 18 publications

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“…However, studies from high volume centers demonstrated that within minorities, specifically African Americans and Hispanics, rates of transplantation had increased after KAS. 6 , 12 Our institution did have the same results. Even though our kidney transplant list is composed of mostly, if not all, Hispanics.…”

Section: Discussionsupporting

confidence: 65%

“…According to a short-term study from Sanchez et al, the implementation of the new KAS has resulted in a more equitable distribution of kidney transplants; there was a decrease in transplants for Caucasians and an increase for Hispanics and African Americans. 6 Other studies suggest the new system has resulted in a higher proportion of transplants in patients with high cPRA with higher quality grafts. 7…”

Section: Introductionmentioning

confidence: 99%

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Failure of the New Kidney Allocation System in a Specific Ethnic Group

Longoria-Dubocq

Pizarro-Gonzalez

Mayorga-Perez

et al. 2020

Preprint

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Introduction: The Kidney Allocation System (KAS) implemented on December 4, 2014, was expected to improve kidney transplant list wait-time and allocate more kidney to high cPRA patients. This study aims to demonstrate outcomes after the implementation of the KAS in a Hispanic transplant center. Methods: Retrospective study from a prospectively maintained database from a single-transplant center. Included all DDKT from July 2013 to June 2016. Compare and analyze DDKT selection and outcomes before and after KAS implementation. Results: The overall number of kidney transplants performed during this period was 220. All of the patients were Hispanic. Included 50.5% Pre-KAS and 49.5% Post-KAS. Pre-KAS group had a significantly shorter waiting-time list than the post-KAS group, 900.05 vs 1126.75 respectively. EPTS less than 20% significantly improved in the Post-KAS group compared to the Pre-KAS group, 41.3% vs 20.9% respectively. No differences observed in KDPI, 1-year graft failure, or 1-year mortality rates. Conclusion: This might be the first Hispanic only cohort evaluating the effects of KAS on a moderate volume kidney transplant center. The new system increased the wait-time list by approximately 25%, and it did not improve graft quality, graft failure, or mortality rates.

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Section: Discussionsupporting

confidence: 65%

Section: Introductionmentioning

confidence: 99%

Failure of the New Kidney Allocation System in a Specific Ethnic Group

Longoria-Dubocq

Pizarro-Gonzalez

Mayorga-Perez

et al. 2020

Preprint

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“…Recent changes in deceased donor allocation in the United States (US) under the new Kidney Allocation System (KAS) implemented in 2014 were associated with an increase in DGF—presumably due to increased cold ischemia time that resulted from increased organ sharing and increased dialysis vintage among recipients 11,12 . With the increased focus on the use of less‐than‐ideal organs to lower the currently high discard rate, there is concern of a further increase in the incidence of DGF in the United States—and the attendant costs associated with this complication 12,13 . Increased costs that are incurred when using less‐than‐ideal organs that progress to DGF potentially deter transplant centers from accepting these organs despite evidence that this approach would still be cost‐effective for the healthcare system vs staying on dialysis, while also providing significant quality of life and mortality benefits 13 .…”

Section: Introductionmentioning

confidence: 99%

“…With the increased focus on the use of less‐than‐ideal organs to lower the currently high discard rate, there is concern of a further increase in the incidence of DGF in the United States—and the attendant costs associated with this complication 12,13 . Increased costs that are incurred when using less‐than‐ideal organs that progress to DGF potentially deter transplant centers from accepting these organs despite evidence that this approach would still be cost‐effective for the healthcare system vs staying on dialysis, while also providing significant quality of life and mortality benefits 13 . We attempt, using direct hospital‐reported charge data from the Premier Healthcare Database, to estimate the increased financial costs incurred with DGF following kidney transplantation.…”

Section: Introductionmentioning

confidence: 99%

Financial impact of delayed graft function in kidney transplantation

Kim

Zheng

King

et al. 2020

Clinical Transplantation

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Increased utilization of suboptimal organs in response to organ shortage has resulted in increased incidence of delayed graft function (DGF) after transplantation. Although presumed increased costs associated with DGF are a deterrent to the utilization of these organs, the financial burden of DGF has not been established. We used the Premier Healthcare Database to conduct a retrospective analysis of healthcare resource utilization and costs in kidney transplant patients (n = 12 097) between 1/1/2014 and 12/31/2018. We compared cost and hospital resource utilization for transplants in high‐volume (n = 8715) vs low‐volume hospitals (n = 3382), DGF (n = 3087) vs non‐DGF (n = 9010), and recipients receiving 1 dialysis (n = 1485) vs multiple dialysis (n = 1602). High‐volume hospitals costs were lower than low‐volume hospitals ($103 946 vs $123 571, P < .0001). DGF was associated with approximately $18 000 (10%) increase in mean costs ($130 492 vs $112 598, P < .0001), 6 additional days of hospitalization (14.7 vs 8.7, P < .0001), and 2 additional ICU days (4.3 vs 2.1, P < .0001). Multiple dialysis sessions were associated with an additional $10 000 compared to those with only 1. In conclusion, DGF is associated with increased costs and length of stay for index kidney transplant hospitalizations and payment schemes taking this into account may reduce clinicians’ reluctance to utilize less‐than‐ideal kidneys.

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“…A study of the OPTN data up to 2016 found a 69% higher odds in delayed graft function in recipients <10 years of age post-KAS compared with pre-KAS explained by age or size of donors and pretransplant dialysis duration (11). Separately, another study reported higher likelihood of delayed graft function post-KAS for all adults but more so for those of Black or Hispanic race and ethnicity (6). Our study finds that with prolonged follow-up time, delayed graft function did not differ among racial and ethnic pediatric groups.…”

Section: Discussionmentioning

confidence: 99%

Racial Disparities in Pediatric Kidney Transplantation under the New Kidney Allocation System in the United States

Krissberg

Kaufmann

Gupta

et al. 2021

CJASN

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Background and objectivesIn December 2014, the Kidney Allocation System (KAS) was implemented to improve equity in access to transplantation, but preliminary studies in children show mixed results. Thus, we aimed to assess how the 2014 KAS policy change affected racial and ethnic disparities in pediatric kidney transplantation access and related outcomes.Design, setting, participants, & measurementsWe performed a retrospective cohort study of children <18 years of age active on the kidney transplant list from 2008 to 2019 using the Scientific Registry of Transplant Recipients. Log-logistic accelerated failure time models were used to determine the time from first activation on the transplant list and the time on dialysis to deceased donor transplant, each with KAS era or race and ethnicity as the exposure of interest. We used logistic regression to assess odds of delayed graft function. Log-rank tests assessed time to graft loss within racial and ethnic groups across KAS eras.ResultsAll children experienced longer wait times from activation to transplantation post-KAS. In univariable analysis, Black and Hispanic children and other children of color experienced longer times from activation to transplant compared with White children in both eras; this finding was largely attenuated after multivariable analysis (time ratio, 1.16; 95% confidence interval, 1.01 to 1.32; time ratio, 1.13; 95% confidence interval, 1.00 to 1.28; and time ratio, 1.17; 95% confidence interval, 0.96 to 1.41 post-KAS, respectively). Multivariable analysis also showed that racial and ethnic disparities in time from dialysis initiation to transplantation in the pre-KAS era were mitigated in the post-KAS era. There were no disparities in odds of delayed graft function. Black and Hispanic children experienced longer times with a functioning graft in the post-KAS era.ConclusionsNo racial and ethnic disparities from activation to deceased donor transplantation were seen before or after implementation of the KAS in multivariable analysis, whereas time on dialysis to transplantation and odds of short-term graft loss improved in equity after the implementation of the KAS, without compromising disparities in delayed graft function.PodcastThis article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2021_12_07_CJN06740521.mp3

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Evolving Trends in Racial Disparities for Peri-Operative Outcomes with the New Kidney Allocation System (KAS) Implementation

Cited by 8 publications

References 18 publications

Failure of the New Kidney Allocation System in a Specific Ethnic Group

Failure of the New Kidney Allocation System in a Specific Ethnic Group

Financial impact of delayed graft function in kidney transplantation

Racial Disparities in Pediatric Kidney Transplantation under the New Kidney Allocation System in the United States

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