Has the Department of Veterans Affairs Found a Way to Avoid Racial Disparities in the Evaluation Process for Kidney Transplantation?

Abstract

Background Minority groups are affected by significant disparities in kidney transplantation (KT) in Veterans Affairs (VA) and non-VA transplant centers. But, prior VA studies have been limited to retrospective, secondary database analyses that focused on multiple stages of the KT process simultaneously. Our goal was to determine whether disparities during the evaluation period for KT exist in the VA as has been found in non-VA settings. Methods We conducted a multi-center longitudinal cohort study of 602 patients undergoing initial evaluation for KT at 4 National VA KT Centers. Participants completed a telephone interview to determine whether, after controlling for medical factors, differences in time to acceptance for transplant were explained by patients' demographic, cultural, psychosocial, or transplant knowledge factors. Results There were no significant racial disparities in the time to acceptance for KT [Log-Rank χ2 =1.04; p=0.594]. Younger age (HR 0.98; 95% CI 0.97–0.99), fewer comorbidities (HR 0.89; 95% CI 0.84–0.95), being married (HR 0.81; 95% CI 0.66–0.99), having private and public insurance (HR 1.29; 95% CI 1.03–1.51), and moderate or greater levels of depression (HR 1.87; 95% CI 1.03–3.29) predicted a shorter time to acceptance. The influence of preference for type of KT (deceased or living donor) and transplant center location on days to acceptance varied over time. Conclusions Our results indicate that the VA National Transplant System did not exhibit the racial disparities in evaluation for KT as have been found in non-VA transplant centers.

Racial Disparities in Nephrology Consultation and Disease Progression among Veterans with CKD: An Observational Cohort Study

“…Some studies have shown reduced racial disparity in health outcomes in the VHA, which does not have some of the barriers to subspecialty care that are prevalent elsewhere in the United States and that may particularly disadvantage minorities. 22,23 Kovesdy et al contrasted outcomes for a large cohort of veterans without CKD who received care in the VHA versus the general population. Black veterans had 24% lower all-cause mortality, whereas black patients in the general population experienced a 42% higher adjusted mortality versus white patients.…”

Significantly Lower Rates of Kidney Transplantation among Candidates Listed with the Veterans Administration: A National and Local Comparison

“…Among the selected patients who were evaluated at VA transplant centers from the study above, 30% were not listed. 17 Once listed, living donor transplantation is the best option for all kidney transplant candidates, and our data show that the rate of living donation was particularly low in the VA transplant population compared with privately insured patients. In the study above, 41% of surveyed patients evaluated at VA transplant centers reported having a living donor candidate available.…”

“…16 A recent analysis looked at various factors related to the time from evaluation at a VA transplant center to successful listing. 17 That study did not account for the barriers and delays that may occur before evaluation at the transplant center. VA transplant centers may turn a patient down sight-unseen or request additional testing that may delay evaluation.…”

“…In the study above, 41% of surveyed patients evaluated at VA transplant centers reported having a living donor candidate available. 17 However, living donor transplantation makes up ,10% of transplants overall in VA centers. Barriers to living donation may exist within the VA system.…”

Cognitive assessment in a predominantly Hispanic and Native American population in New Mexico and its association with kidney transplant wait‐listing

“…Multiple factors including age, race, socioeconomic status and medical comorbidities affect KT evaluation and wait‐listing . Racial minorities including African Americans, Hispanics and Native Americans repeatedly have been shown to have less access to renal transplantation, and whether cognitive impairment plays a role in the lower probability of wait‐listing and KT in these populations has never been investigated.…”