The Geography of Kidney Transplantation in the United States

Abstract

The distance kidney transplant patients live from the centers where they undergo transplantation could affect long-term care and outcomes, but little is known about this distance and its associations. We used data from the United States Renal Data System to examine distance between home and transplant cen- Hispanics lived closer (14.7 miles) than non-Hispanics (24.3 miles). Even after adjusting for center density, we found substantial regional variability, with median distance of 15.1 miles for patients living in the Northeast and 40.6 miles for those in the Southeast. Distance was also associated with center size, median zip code income, listing on more than one deceased-donor waiting list and other factors, but greater distance (adjusted for these other factors) was not associated with worse patient or graft survival. The substantial variability in geographical access to kidney transplantation could have important implications for long-term care.

Access to Kidney Transplantation Among Remote- and Rural-Dwelling Patients With Kidney Failure in the United States

“…A recent study from the United States did not report on transplant rates but found that posttransplantation clinical outcomes were similar for those living closer to and farther from a transplant center. 24 Aside from proximity to a transplant center, a second geographic consideration that might influence access to and utilization of kidney transplantation is rural residence-sometimes defined as living outside a major urban area. 25 In the United States, there currently is considerable interest in providing rural dwellers with equitable access to medical services.…”

Cash, rewards, and benefits in organ transplantation: an open letter to Senator Arlen Specter

“…The causes of these variations are not fully understood [15]. They do not only relate to the availability of living donors, other factors, including education; program size, and staffing; and resources; play a role to an extent that has not been systematically evaluated.…”

Who Is Caring for Kidney Transplant Patients? Variation by Region, Transplant Center, and Patient Characteristics

“…Our prior work showed that Native Americans tend to live farther away from their transplant centers than other ethnic groups and are thus less likely to follow-up at the transplant center [8]. Plausibly, living-donor kidney recipients and patients with low immunological risk (such as low panel reactive antibody) may be less likely to need follow-up care than higher-risk patients.…”

“…However, even after adjusting for these variables, substantial unexplained racial/ethnic variation remained. Despite living close to their transplant centers [8], Hispanics were less likely to receive follow-up care there.…”