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Racial disparities in living donor kidney transplantation in the United States.
Clin Transplant. 2022 03; 36(3):e14547.CT

Abstract

Living donor kidney transplant (LDKT) is the best treatment for end-stage kidney disease, but there are racial disparities in LDKT rates. To study putative mechanisms of these disparities, we identified 58 752 adult kidney transplant candidates first activated on the United States kidney transplant waitlist 2015-2016 and defined four exposure groups by race/primary payer: African American/Medicaid, African American/NonMedicaid, Non-African American/Medicaid, Non-African American/NonMedicaid. We performed competing risk regression to compare risk of LDKT between groups. Among included candidates, 30% had African American race and 9% had Medicaid primary payer. By the end of follow up, 16% underwent LDKT. The cumulative incidence of LDKT was lowest for African American candidates regardless of payer. Compared to African American/Non-Medicaid candidates, the adjusted likelihood of LDKT was higher for both Non-African American/Medicaid (HR 1.60, 95%CI 1.43-1.78) and Non-African American/Non-Medicaid candidates (HR 2.66, 95%CI 2.50-2.83). Results were similar when analyzing only candidates still waitlisted > 2 years after initial activation or candidates with type O blood. Among 9639 candidates who received LDKT, only 13% were African American. Donor-recipient relationships were similar for African American and Non-African American recipients. These findings indicate African American candidates have a lower incidence of LDKT than candidates of other races, regardless of primary payer.

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Publisher Full Text (DOI)

Authors+Show Affiliations

Husain SA
Department of Medicine, Division of Nephrology, Columbia University Medical Center, New York, New York, USA. The Columbia University Renal Epidemiology (CURE) Group, New York, New York, USA.
King KL
Department of Medicine, Division of Nephrology, Columbia University Medical Center, New York, New York, USA. The Columbia University Renal Epidemiology (CURE) Group, New York, New York, USA.
Adler JT
Department of Surgery, Division of Transplant Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA. Center for Surgery and Public Health at Brigham and Women's Hospital, Boston, Massachusetts, USA.
Mohan S
Department of Medicine, Division of Nephrology, Columbia University Medical Center, New York, New York, USA. The Columbia University Renal Epidemiology (CURE) Group, New York, New York, USA. Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA.

MeSH

AdultBlack or African AmericanFemaleHumansKidneyKidney Failure, ChronicKidney TransplantationLiving DonorsMaleUnited States

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

34843124

Citation

Husain, S Ali, et al. "Racial Disparities in Living Donor Kidney Transplantation in the United States." Clinical Transplantation, vol. 36, no. 3, 2022, pp. e14547.
Husain SA, King KL, Adler JT, et al. Racial disparities in living donor kidney transplantation in the United States. Clin Transplant. 2022;36(3):e14547.
Husain, S. A., King, K. L., Adler, J. T., & Mohan, S. (2022). Racial disparities in living donor kidney transplantation in the United States. Clinical Transplantation, 36(3), e14547. https://doi.org/10.1111/ctr.14547
Husain SA, et al. Racial Disparities in Living Donor Kidney Transplantation in the United States. Clin Transplant. 2022;36(3):e14547. PubMed PMID: 34843124.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Racial disparities in living donor kidney transplantation in the United States. AU - Husain,S Ali, AU - King,Kristen L, AU - Adler,Joel T, AU - Mohan,Sumit, Y1 - 2021/12/13/ PY - 2021/11/18/revised PY - 2021/07/08/received PY - 2021/11/19/accepted PY - 2021/11/30/pubmed PY - 2022/4/26/medline PY - 2021/11/29/entrez KW - epidemiology KW - health disparities KW - living donor kidney transplant KW - race SP - e14547 EP - e14547 JF - Clinical transplantation JO - Clin Transplant VL - 36 IS - 3 N2 - Living donor kidney transplant (LDKT) is the best treatment for end-stage kidney disease, but there are racial disparities in LDKT rates. To study putative mechanisms of these disparities, we identified 58 752 adult kidney transplant candidates first activated on the United States kidney transplant waitlist 2015-2016 and defined four exposure groups by race/primary payer: African American/Medicaid, African American/NonMedicaid, Non-African American/Medicaid, Non-African American/NonMedicaid. We performed competing risk regression to compare risk of LDKT between groups. Among included candidates, 30% had African American race and 9% had Medicaid primary payer. By the end of follow up, 16% underwent LDKT. The cumulative incidence of LDKT was lowest for African American candidates regardless of payer. Compared to African American/Non-Medicaid candidates, the adjusted likelihood of LDKT was higher for both Non-African American/Medicaid (HR 1.60, 95%CI 1.43-1.78) and Non-African American/Non-Medicaid candidates (HR 2.66, 95%CI 2.50-2.83). Results were similar when analyzing only candidates still waitlisted > 2 years after initial activation or candidates with type O blood. Among 9639 candidates who received LDKT, only 13% were African American. Donor-recipient relationships were similar for African American and Non-African American recipients. These findings indicate African American candidates have a lower incidence of LDKT than candidates of other races, regardless of primary payer. SN - 1399-0012 UR - https://www.unboundmedicine.com/medline/citation/34843124/Racial_disparities_in_living_donor_kidney_transplantation_in_the_United_States_ DB - PRIME DP - Unbound Medicine ER -