Racial Differences in Determinants of Live Donor Kidney Transplantation in the United States

Abstract

Few studies have compared determinants of live donor kidney transplantation (LDKT) across all major US racial-ethnic groups. We compared determinants of racial-ethnic differences in LDKT among 208 736 patients who initiated treatment for end-stage kidney disease during 2005–2008. We performed proportional hazards and bootstrap analyses to estimate differences in LDKT attributable to sociodemographic and clinical factors. Mean LDKT rates were lowest among blacks (1.19 per 100 person-years [95% CI: 1.12–1.26]), American Indians/Alaska Natives-AI/ANs (1.40 [1.06–1.84]) and Pacific Islanders (1.10 [0.78–1.84]), intermediate among Hispanics (2.53 [2.39–2.67]) and Asians (3.89 [3.51–4.32]), and highest among whites (6.46 [6.31– 6.61]). Compared with whites, the largest proportion of the disparity among blacks (20%) and AI/ANs (29%) was attributed to measures of predialysis care, while the largest proportion among Hispanics (14%) was attributed to health insurance coverage. Contextual poverty accounted for 16%, 4%, 18%, and 6% of the disparity among blacks, Hispanics, AI/ANs and Pacific Islanders but none of the disparity among Asians. In the United States, significant disparities in rates of LDKT persist, but determinants of these disparities vary by race-ethnicity. Efforts to expand preESKD insurance coverage, to improve access to high-quality predialysis care and to overcome socioeconomic barriers are important targets for addressing disparities in LDKT.

Inpatient Mortality and Morbidity for Dialysis-Dependent Patients Undergoing Primary Total Hip or Knee Arthroplasty

“…Nonetheless, an epidemiologic study showed that African Americans develop end-stage renal disease three times more frequently than Caucasians 15 , yet black patients are less likely to receive a kidney transplant 16,17 . These reports supported our finding that a larger percentage of dialysisdependent patients who undergo primary hip or knee arthroplasty are black.…”

Impact of Age, Race and Ethnicity on Dialysis Patient Survival and Kidney Transplantation Disparities

“…[19, 20, 22] LDKT is the treatment of choice for dialysis patients given that it confers greater patient survival and quality of life compared with dialysis, as well as improved early graft function, lower rates of acute rejection, and greater graft and patient survival compared to DDKT. [33-37] To our knowledge, ours is the first study to show that African-Americans and Hispanics are less likely to undergo kidney transplantation across all age categories, and that these disparities are magnified for LDKT and particularly LUDKT.…”

“…[17, 18] Numerous studies show that African-Americans and Hispanics have decreased access to living donor kidney transplantation (LDKT) and deceased donor kidney transplantation (DDKT), but it is not known if these disparities exist across all categories of age. [19-22] Thus to better inform the field, we sought to examine age as a modifier of the association between African-American and Hispanic race/ethnicity with 1) all-cause death and 2) receipt of kidney transplantation in a contemporary cohort of patients with detailed information on sociodemographics, comorbidities, and laboratory data from a large national dialysis organization.…”

Living Donor Kidney Transplantation

“…Different patterns of racial and ethnic disparities in kidney transplantation suggest that some minorities, relative to non-Hispanic white patients, may experience more kidney transplant access barriers, be more likely to have initiated dialysis at the time of transplant referral, wait longer for a deceased donor transplant, have higher mortality rates on the waiting list, and have less optimal transplant outcomes (4,6,(13)(14)(15)(16)(17)(18)(19). Because the proportion of patients on the kidney transplant waiting list is increasing for racial/ethnic minorities (while declining for nonHispanic whites) (1), the extreme shortage of deceased donor kidneys is likely to exacerbate these transplant disparities in the years ahead.…”