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Author Notes:

Corresponding Author: Rachel E. Patzer, PhD, MPH, Associate Professor, Department of Surgery, Division of Transplantation, Emory University School of Medicine, 101 Woodruff Circle, 5101 WMB, Atlanta, GA 30322, rpatzer@emory.edu, Phone: (404)-727-6047.

The authors of this manuscript have no conflicts of interest to disclose as described by the American Journal of Transplantation.

Subjects:

Research Funding:

This work was supported by the National Institute on Minority Health and Health Disparities (Grant #R01MD010290).

Keywords:

  • Science & Technology
  • Life Sciences & Biomedicine
  • Surgery
  • Transplantation
  • epidemiology
  • ethics and public policy
  • ethnicity
  • race
  • health services and outcomes research
  • kidney transplantation
  • nephrology
  • organ allocation
  • organ procurement and allocation
  • quality of care
  • care delivery
  • RENAL-TRANSPLANTATION
  • UNITED-STATES
  • SOCIOECONOMIC-STATUS
  • RACIAL DISPARITIES
  • ETHNIC DISPARITIES
  • ACCESS
  • CARE
  • RACE
  • RATES
  • BLACK

Racial/ethnic disparities in waitlisting for deceased donor kidney transplantation 1 year after implementation of the new national kidney allocation system

Tools:

Journal Title:

American Journal of Transplantation

Volume:

Volume 18, Number 8

Publisher:

, Pages 1936-1946

Type of Work:

Article | Post-print: After Peer Review

Abstract:

The impact of a new national kidney allocation system (KAS) on access to the national deceased-donor waiting list (waitlisting) and racial/ethnic disparities in waitlisting among US end-stage renal disease (ESRD) patients is unknown. We examined waitlisting pre- and post-KAS among incident (N = 1 253 100) and prevalent (N = 1 556 954) ESRD patients from the United States Renal Data System database (2005-2015) using multivariable time-dependent Cox and interrupted time-series models. The adjusted waitlisting rate among incident patients was 9% lower post-KAS (hazard ratio [HR]: 0.91; 95% confidence interval [CI], 0.90-0.93), although preemptive waitlisting increased from 30.2% to 35.1% (P <.0001). The waitlisting decrease is largely due to a decline in inactively waitlisted patients. Pre-KAS, blacks had a 19% lower waitlisting rate vs whites (HR: 0.81; 95% CI, 0.80-0.82); following KAS, disparity declined to 12% (HR: 0.88; 95% CI, 0.85-0.90). In adjusted time-series analyses of prevalent patients, waitlisting rates declined by 3.45/10 000 per month post-KAS (P <.001), resulting in ≈146 fewer waitlisting events/month. Shorter dialysis vintage was associated with greater decreases in waitlisting post-KAS (P <.001). Racial disparity reduction was due in part to a steeper decline in inactive waitlisting among minorities and a greater proportion of actively waitlisted minority patients. Waitlisting and racial disparity in waitlisting declined post-KAS; however, disparity remains.

Copyright information:

© 2018 The American Society of Transplantation and the American Society of Transplant Surgeons

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