Listing at non-local transplant centers is associated with increased access to deceased donor kidney transplantation

• Type of Material: Article
• Authors: Katherine Ross-Driscoll, Emory University; Jonathan Gunasti, Emory University; Raymond Lynch, Emory University; Allan Massie, Johns Hopkins University; Dorry L Segev, Johns Hopkins University; Jon Snyder, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota; David Axelrod, University of Iowa; Rachel Patzer, Emory University
• Language: English
• Date: 2022-04-06
• Publisher: WILEY
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2022 American Society of Transplantation & American Society of Transplant Surgeons. Published by Elsevier Inc. All rights reserved. Published by Elsevier Inc.
• Final Published Version (URL): http://dx.doi.org/10.1111/ajt.17044
• Title of Journal or Parent Work: AMERICAN JOURNAL OF TRANSPLANTATION
• Volume: 22
• Issue: 7
• Start Page: 1813
• End Page: 1822
• Keywords: Transplantation; nephrology; kidney transplantation; Science & Technology; health services and outcomes research; DISTANCE; registry analysis; Surgery; registry; disparities; Life Sciences & Biomedicine; TRAVEL; patient characteristics; Scientific Registry for Transplant Recipients (SRTR); DIAGNOSIS
• Research Categories: Health Sciences, Epidemiology; Health Sciences, Medicine and Surgery; Health Sciences, Oncology

Abstract

The ability of kidney transplant candidates to travel outside of their usual place of care varies by sociodemographic factors, potentially exacerbating disparities in access. We used Transplant Referral Regions (TRRs) to overcome previous methodological barriers of using geographic distance to assess the characteristics and outcomes of patients listed for kidney transplant at centers in neighboring TRR or beyond neighboring TRRs. Among listed kidney transplant candidates, 20.9% traveled to a neighbor and 5.6% beyond a neighbor. A higher proportion of travelers were White, had some college education, and lived in ZIP codes with lower poverty. Travel to a neighbor was associated with a 7% increase in likelihood of deceased donor transplant (cHR: 1.07, 95% CI: 1.05, 1.09) and traveling beyond a neighbor with a 19% increase (cHR: 1.19, 95% CI: 1.15, 1.24). Travelers had similar rates of living donor transplant and waitlist mortality as patients who did not travel; those who traveled beyond a neighbor had slightly lower posttransplant mortality (HR: 0.91, 95% CI: 0.83, 0.99). In conclusion, the ability to travel outside of the recipient's assigned TRR increases access to transplantation and improves long-term survival. (Figure presented.).