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Trends in Disparities in Preemptive Kidney Transplantation in the United States.

Authors
  • King, Kristen L1, 2
  • Husain, Syed Ali1, 2
  • Jin, Zhezhen3
  • Brennan, Corey2
  • Mohan, Sumit4, 2, 5
  • 1 Division of Nephrology, Department of Medicine, Columbia University Medical Center, New York, New York.
  • 2 The Columbia University Renal Epidemiology (CURE) Group, New York, New York.
  • 3 Department of Biostatistics and.
  • 4 Division of Nephrology, Department of Medicine, Columbia University Medical Center, New York, New York; [email protected]
  • 5 Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York.
Type
Published Article
Journal
Clinical Journal of the American Society of Nephrology
Publisher
American Society of Nephrology
Publication Date
Oct 07, 2019
Volume
14
Issue
10
Pages
1500–1511
Identifiers
DOI: 10.2215/CJN.03140319
PMID: 31413065
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Long wait times for deceased donor kidneys and low rates of preemptive wait-listing have limited preemptive transplantation in the United States. We aimed to assess trends in preemptive deceased donor transplantation with the introduction of the new Kidney Allocation System (KAS) in 2014 and identify whether key disparities in preemptive transplantation have changed. We identified adult deceased donor kidney transplant recipients in the United States from 2000 to 2018 using the Scientific Registry of Transplant Recipients. Preemptive transplantation was defined as no dialysis before transplant. Associations between recipient, donor, transplant, and policy era characteristics and preemptive transplantation were calculated using logistic regression. To test for modification by KAS policy era, an interaction term between policy era and each characteristic of interest was introduced in bivariate and adjusted models. The proportion of preemptive transplants increased after implementation of KAS from 9.0% to 9.8%, with 1.10 (95% confidence interval [95% CI], 1.06 to 1.14) times higher odds of preemptive transplantation post-KAS compared with pre-KAS. Preemptive recipients were more likely to be white, older, female, more educated, hold private insurance, and have ESKD cause other than diabetes or hypertension. Policy era significantly modified the association between preemptive transplantation and race, age, insurance status, and Human Leukocyte Antigen zero-mismatch (interaction P<0.05). Medicare patients had a significantly lower odds of preemptive transplantation relative to private insurance holders (pre-KAS adjusted OR, [aOR] 0.26; [95% CI, 0.25 to 0.27], to 0.20 [95% CI, 0.18 to 0.22] post-KAS). Black and Hispanic patients experienced a similar phenomenon (aOR 0.48 [95% CI, 0.45 to 0.51] to 0.41 [95% CI, 0.37 to 0.45] and 0.43 [95% CI, 0.40 to 0.47] to 0.40 [95% CI, 0.36 to 0.46] respectively) compared with white patients. Although the proportion of deceased donor kidney transplants performed preemptively increased slightly after KAS, disparities in preemptive kidney transplantation persisted after the 2014 KAS policy changes and were exacerbated for racial minorities and Medicare patients. Copyright © 2019 by the American Society of Nephrology.

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