New Kidney Allocation System Associated With Increased Rates Of Transplants Among Black And Hispanic Patients

Abstract

Prior to the 2014 implementation of a new kidney allocation system by the United Network for Organ Sharing, white patients were more likely to receive a kidney transplant than black or Hispanic patients. To determine the effect of the new kidney allocation system on these disparities, we examined 179,071 waitlisting events from the United Network for Organ Sharing database from June 2013 to September 2016 and calculated monthly kidney transplantation rates among waitlisted patients. Implementation of the new system was associated with a narrowing of the disparity in the average monthly kidney transplantation rate by 0.29 percentage points for blacks compared to whites (p<0.001) and 0.24 percentage points for Hispanics compared to whites (p<0.001), resulting in both disparities becoming insignificant after implementation of the new system (p=0.45, p=0.18).

Racial/ethnic disparities in waitlisting for deceased donor kidney transplantation 1 year after implementation of the new national kidney allocation system

“…The share of minority transplant recipients increased after KAS. (30, 38) Our study extends these previous findings by showing how the policy influenced waitlisting. There are several potential explanations for why there was a reduction in the black vs. white disparity in waitlisting following the policy change.…”

“…(17, 32) In our study, Hispanics had a higher overall incidence of waitlisting but a slower time to waitlisting than white patients. Other analyses(30) have also reported that KAS increased transplant rates for Hispanics after waitlisting, thus reducing the overall ethnic disparity in transplant access. We also report that waitlisting for Asian patients decreased after KAS, but this group still had the highest waitlisting rate among all racial/ethnic groups, as previously reported.…”

Renal Function Variability: An Independent Risk Factor for Graft Loss and Death following Kidney Transplantation

“…The recent evolution in recipient demographics and expansion of the donor pool have introduced several important variables that may contribute to the lack of improvement in longterm allograft survival but may be better matched with predicted patient survival [4][5][6][7]. Although the changes in the kidney allocation scoring system have led to presumed improved equity in organ availability for disadvantaged recipients, the transplant community is in need of an objective measure to aid in determining which patients are at the highest risk for graft failure [5][6][7][8]. Implementation of an easy, cost-effective measure that can be utilized during routine lab review to target patients for intervention is needed.…”

Development and preliminary evaluation of ilearnKAS: An animated video about kidney allocation to support transplant decision‐making

“…IQR, interquartile range; SD, standard deviation. After institution of the new national kidney allocation system in December 2014, 5 access to transplantation for AAs improved,6,7 yet racial disparities in gaining wait-list placement still persisted 16. b Effect size, r = Z/√N; r = Point biserial correlation.…”