Racial differences in completion of the living kidney donor evaluation process

Abstract

Racial disparities in living donor kidney transplantation (LDKT) persist but the most effective target to eliminate these disparities remains unknown. One potential target could be delays during completion of the live donor evaluation process. We studied racial differences in progression through the evaluation process for 247 African American (AA) and 664 non-AA living donor candidates at our center between January 2011 and March 2015. AA candidates were more likely to be obese (38% vs 22%: P < .001), biologically related (66% vs 44%: P < .001), and live ≤50 miles from the center (64% vs 37%: P < .001) than non-AAs. Even after adjusting for these differences, AAs were less likely to progress from referral to donation (aHR for AA vs non-AA: 0.47 P = .01). We then assessed racial differences in completion of each step of the evaluation process and found disparities in progression from medical screening to in-person evaluation (aHR: 0.62 P = .02) and from clearance to donation (aHR: 0.51 P = .02), compared with from referral to medical screening (aHR: 1.02 P = .95) and from in-person evaluation to clearance (aHR: 0.93 P = .54). Delays may be a manifestation of the transplant candidate's social network, thus, targeted efforts to optimize networks for identification of donor candidates may help address LDKT disparities.

Association of Socioeconomic Status and Comorbidities with Racial Disparities during Kidney Transplant Evaluation

“…This is consistent with work that suggests immunologic concerns and availability of donor organs are important predictors for transplant (2,17). Prior national policies have focused on allocation stage of organ transplantation (32,33), yet disparities in transplantation may be widening between 1995 and 2014 (3) and within donor evaluation process (34).…”

The first increase in live kidney donation in the United States in 15 years

“…This is a reminder that national strategies are needed to address racial disparities in access to live donor kidney transplantation. 28,29 Unlike studies that have been concerned with the decade-long decline in live kidney donation in the United States, 1,2,4 herein we describe the first sustained increase in donors and in 2019 the highest number of donors to date. Moreover, our study reveals that the increase in kidney paired donors was predominantly among those who were white.…”

Bariatric surgery for prospective living kidney donors with obesity?

“…Limited data from single-center studies demonstrate that exclusion rates for obesity vary from 1.8% to 25%. [4][5][6][7][8][9][10] Similar rates of exclusion apply to hypertension (7.6% to 21%), although exclusion due to diabetes is relatively rare (1.2% to 3.5%). Exclusion rates due to obesity-related comorbidities may be underestimations, as patients are more likely to be excluded for self-reported obesity during initial phone screening than for undiagnosed comorbidities that are discovered during transplant donor clinic visit.…”