Impact of having potential living donors on ethnic/racial disparities in access to kidney transplantation

Elisa J Gordon, Jungwha Lee, Raymond Kang, Juan Carlos Caicedo, Elisa J Gordon, Jungwha Lee, Raymond Kang, Juan Carlos Caicedo

Abstract

Racial/ethnic disparities persist in patients' access to living donor kidney transplantation (LDKT). This study assessed the impact of having available potential living donors (PLDs) on candidates' receipt of a kidney transplant (KT) and LDKT at two KT programs. Using data from our clinical trial of waitlisted candidates (January 1, 2014-December 31, 2019), we evaluated Hispanic and Non-Hispanic White (NHW) KT candidates' number of PLDs. Multivariable logistic regression assessed the impact of PLDs on transplantation (KT vs. no KT; for KT recipients, LDKT vs. deceased donor KT). A total of 847 candidates were included, identifying as Hispanic (45.8%) or NHW (54.2%). For Site A, both Hispanic (adjusted OR = 2.26 [95% CI 1.13-4.53]) and NHW (OR = 2.42 [1.10-5.33]) candidates with PLDs completing the questionnaire were more likely to receive a KT. For Site B, candidates with PLDs were not significantly more likely to receive KT. Among KT recipients at both sites, Hispanic (Site A: OR = 21.22 [2.44-184.88]; Site B: OR = 25.54 [7.52-101.54]), and NHW (Site A: OR = 37.70 [6.59-215.67]; Site B: OR = 15.18 [5.64-40.85]) recipients with PLD(s) were significantly more likely to receive a LDKT. Our findings suggest that PLDs increased candidates' likelihood of KT receipt, particularly LDKT. Transplant programs should help candidates identify PLDs early in transplant evaluation.

Trial registration: ClinicalTrials.gov NCT03276390.

Keywords: Latinx; health disparities; kidney failure.

© 2022 The Authors. American Journal of Transplantation published by Wiley Periodicals LLC on behalf of The American Society of Transplantation and the American Society of Transplant Surgeons.

Figures

FIGURE 1
FIGURE 1
(A) Potential living donor's relationship to Hispanic candidate (%), N = 228. (B) Potential living donor's relationship to NHW candidate (%), N = 313.

References

    1. Axelrod DA, McCullough KP, Brewer ED, Becker BN, Segev DL, Rao PS. Kidney and pancreas transplantation in the United States, 1999‐2008: the changing face of living donation. Am J Transplant. 2010;10(4 Pt 2):987‐1002. doi:10.1111/j.1600-6143.2010.03022.x
    1. Lamb KE, Lodhi S, Meier‐Kriesche HU. Long‐term renal allograft survival in the United States: a critical reappraisal. Am J Transplant. 2011;11(3):450‐462. doi:10.1111/j.1600-6143.2010.03283.x
    1. Gozdowska J, Zatorski M, Torchalla P, et al. Living‐donor versus deceased‐donor kidney transplantation: comparison of psychosocial consequences for recipients. Transplant Proc. 2016;48(5):1498‐1505. doi:10.1016/j.transproceed.2016.01.075
    1. Yohanna S, Naylor KL, Mucsi I, et al. A quality improvement intervention to enhance access to kidney transplantation and living kidney donation (EnAKT LKD) in patients with chronic kidney disease: clinical research protocol of a cluster‐randomized clinical trial. Can J Kidney Health Dis. 2021;8:2054358121997266. doi:10.1177/2054358121997266
    1. Garg AX. Helping more patients receive a living donor kidney transplant. Clin J Am Soc Nephrol. 2018;13(12):1918‐1923. doi:10.2215/cjn.00760118
    1. Purnell TS, Luo X, Cooper LA, et al. Association of race and ethnicity with live donor kidney transplantation in the United States from 1995 to 2014. JAMA. 2018;319(1):49‐61. doi:10.1001/jama.2017.19152
    1. OPTN/UNOS . Organ Procurement Transplant Network/United Network for Organ Sharing. Transplants by donor type. U.S. Transplants Performed: January 1, 1988 ‐ December 31, 2021 [] Based on OPTN data as of January 16, 2022. (Accessed January 17, 2022). . 2021.
    1. Purnell TS, Hall YN, Boulware LE. Understanding and overcoming barriers to living kidney donation among racial and ethnic minorities in the United States. Adv Chronic Kidney Dis. 2012;19(4):244‐251.
    1. Gordon EJ, Mullee JO, Ramirez DI, et al. Hispanic/Latino concerns about living kidney donation: a focus group study. Prog Transplant. 2014;24(2):152‐162. doi:10.7182/pit2014946
    1. Siegel JT, O'Brien EK, Alvaro EM, Poulsen JA. Barriers to living donation among low‐resource Hispanics. Qual Health Res. 2014;24(10):1360‐1367. doi:10.1177/1049732314546869
    1. Ríos Zambudio A, López‐Navas AI, Garrido G, et al. Attitudes of Latin American immigrants resident in Florida (United States) toward related living kidney donation. Prog Transplant. 2019;29(1):11‐17. doi:10.1177/1526924818817073
    1. Gordon EJ, Romo E, Amórtegui D, et al. Implementing culturally competent transplant care and implications for reducing health disparities: a prospective qualitative study. Health Expect. 2020;23(6):1450‐1465. doi:10.1111/hex.13124
    1. Hall EC, James NT, Garonzik Wang JM, et al. Center‐level factors and racial disparities in living donor kidney transplantation. Am J Transplant. 2012;59(6):849‐857. doi:10.1053/j.ajkd.2011.12.021
    1. Kumar K, King EA, Muzaale AD, et al. A smartphone app for increasing live organ donation. Am J Transplant. 2016;16(12):3548‐3553. doi:10.1111/ajt.13961
    1. Daw J. Of kin and kidneys: do kinship networks contribute to racial disparities in living donor kidney transplantation? Soc Sci Med. 2014;104:42‐47. doi:10.1016/j.socscimed.2013.11.043
    1. Gillespie A, Gardiner HM, Fink EL, Reese PP, Gadegbeku CA, Obradovic Z. Does sex, race, and the size of a kidney transplant Candidate's social network affect the number of living donor requests? A multicenter social network analysis of patients on the kidney transplant waitlist. Transplantation. 2020;104(12):2632‐2641. doi:10.1097/tp.0000000000003167
    1. Gordon EJ, Lee J, Kang RH, et al. A complex culturally targeted intervention to reduce Hispanic disparities in living kidney donor transplantation: an effectiveness‐implementation hybrid study protocol. BMC Health Serv Res. 2018;18(1):368.
    1. Gordon EJ, Lee J, Kang R, et al. Hispanic/Latino disparities in living donor kidney transplantation: role of a culturally competent transplant program. Transplant Direct. 2015;1(8):e29.
    1. Craig P, Dieppe P, Macintyre S, Michie S, Nazareth I, Petticrew M. Developing and evaluating complex interventions: the new Medical Research Council guidance. BMJ. 2008;337:a1655. doi:10.1136/bmj.a1655
    1. Gordon EJ, Uriarte J, Lee J, et al. Effectiveness of a culturally competent care intervention in reducing disparities in Hispanic live donor kidney transplantation: a hybrid trial. Am J Transplant. 2021;22:474‐488.
    1. Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)‐‐a metadata‐driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42(2):377‐381. doi:10.1016/j.jbi.2008.08.010
    1. Gill JS, Hendren E, Dong J, Johnston O, Gill J. Differential association of body mass index with access to kidney transplantation in men and women. Clin J Am Soc Nephrol. 2014;9(5):951‐959. doi:10.2215/cjn.08310813
    1. Alhalel N, Francone NO, Salazar A, et al. Perceptions of a culturally targeted Hispanic kidney transplant program: a mixed methods study. Clin Transplant. 2019;33(6):e13577.
    1. Brown A, Lopez G, Lopez M. Digital divide narrows for latinos as more Spanish speakers and immigrants go online, July 20. [Accessed 12‐13‐21]. 2016.
    1. Purnell T, Xu P, Leca N, Hall Y. Racial differences in determinants of live donor kidney transplantation in the United States. Am J Transplant. 2013;13(6):1557‐1565.
    1. Reeves‐Daniel AM, Farney AC, Fletcher AJ, et al. Ethnicity, medical insurance, and living kidney donation. Clin Transplant. 2013;27(4):E498‐E503. doi:10.1111/ctr.12168
    1. Gordon EJ, Caicedo JC, Ladner DP, Reddy E, Abecassis MM. Transplant center provision of education and culturally and linguistically competent care: a national study. Am J Transplant. 2010;10(12):2701‐2707.
    1. Gordon E, Reddy E, Gil S, et al. A culturally competent transplant program improves Hispanics' knowledge and attitudes about live kidney donation and transplantation. Prog Transplant. 2014;24(1):56‐68.
    1. Vedadi A, Bansal A, Yung P, et al. Ethnic background is associated with no live kidney donor identified at the time of first transplant assessment—an opportunity missed? A single‐center retrospective cohort study. Transpl. Int. 2019;32(10):1030–1043.
    1. Bailey PK, Caskey FJ, MacNeill S, Tomson CRV, Dor F, Ben‐Shlomo Y. Mediators of socioeconomic inequity in living‐donor kidney transplantation: results from a UKmulticenter case‐control study. Transplant Direct. 2020;6(4):e540. doi:10.1097/txd.0000000000000986
    1. Zingmond DS, Parikh P, Louie R, et al. Improving hospital reporting of patient race and ethnicity–approaches to data auditing. Health Services Research. 2015;50(Suppl 1):1372‐1389. doi:10.1111/1475-6773.12324

Source: PubMed

Sponsorer och medarbetare

Medicinska tillstånd

Läkemedelsinterventioner

3
Prenumerera