Dialysis facility referral and start of evaluation for kidney transplantation among patients treated with dialysis in the Southeastern United States

• Type of Material: Article
• Authors: Rachel Patzer, Emory University; Laura McPherson, Emory University; Zhensheng Wang, Emory University; Laura Plantinga, Emory University; Sudeshna Paul, Emory University; Matthew Ellis, Duke University; Derek A DuBay, Medical University of South Carolina; Joshua Wolf, Piedmont Healthcare; Amber Reeves-Daniel, Wake Forest Medical Center, Atlanta; Heather Jones, Vidant Medical Center; Carlos Zayas, Augusta University; Laura Mulloy, Augusta University; Stephen Pastan, Emory University
• Language: English
• Date: 2020-02-11
• Publisher: WILEY
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2020 American Society of Transplantation & American Society of Transplant Surgeons. Published by Elsevier Inc. All rights reserved.
• Final Published Version (URL): http://dx.doi.org/10.1111/ajt.15791
• Title of Journal or Parent Work: AMERICAN JOURNAL OF TRANSPLANTATION
• Volume: 20
• Issue: 8
• Start Page: 2113
• End Page: 2125
• Grant/Funding Information: National Institutes of Health, Grant/Award Number: U01MD010611
• Keywords: patient referral; practice; ACCESS; disparities; dialysis; RACE; ETHNICITY; COMPLETION; epidemiology; kidney transplantation; clinical research; ethnicity; Transplantation; NEPHROLOGISTS; race; BARRIERS; Science & Technology; ASSOCIATION; Life Sciences & Biomedicine; RENAL-TRANSPLANTATION; nephrology; POVERTY; RACIAL DISPARITIES; Surgery; health services and outcomes research

Abstract

Variability in transplant access exists, but barriers to referral and evaluation are underexplored due to lack of national surveillance data. We examined referral for kidney transplantation evaluation and start of the evaluation among 34 857 incident, adult (18-79 years) end-stage kidney disease patients from 690 dialysis facilities in the United States Renal Data System from January 1, 2012 through August 31, 2016, followed through February 2018 and linked data to referral and evaluation data from nine transplant centers in Georgia, North Carolina, and South Carolina. Multivariable-adjusted competing risk analysis examined each outcome. The median within-facility cumulative percentage of patients referred for kidney transplantation within 1 year of dialysis at the 690 dialysis facilities in Network 6 was 33.7% (interquartile range [IQR]: 25.3%-43.1%). Only 48.3% of referred patients started the transplant evaluation within 6 months of referral. In multivariable analyses, factors associated with referral vs evaluation start among those referred at any time differed. For example, black, non-Hispanic patients had a higher rate of referral (hazard ratio [HR]: 1.22; 95% confidence interval [CI]: 1.18-1.27), but lower evaluation start among those referred (HR: 0.93; 95% CI: 0.88-0.98), vs white non-Hispanic patients. Barriers to transplant varied by step, and national surveillance data should be collected on early transplant steps to improve transplant access.