Differences in access to kidney transplantation between hispanic and non-hispanic whites by geographic location in the United States

Cristina M. Arce, Benjamin A. Goldstein, Aya A. Mitani, Colin R. Lenihan, Wolfgang C. Winkelmayer

Research output: Contribution to journalArticlepeer-review

40 Scopus citations

Abstract

Background and objectives Hispanic patients undergoing chronic dialysis are less likely to receive a kidney transplant compared with non-Hispanic whites. This study sought to elucidate disparities in the path to receipt of a deceased donor transplant between Hispanic and non-Hispanic whites. Design, setting, participants, &measurements Using theUS RenalData System, 417, 801 Caucasianswho initiated dialysis between January 1, 1995 and December 31, 2007 with follow-up through 2008were identified. This study investigated time fromfirst dialysis to first kidney transplantation, time fromfirst dialysis towaitlisting, and time from waitlisting to kidney transplantation. Multivariable Cox regression estimated cause-specific hazard ratios (HRCS) and subdistribution (competing risk) hazard ratios (HRSD) for Hispanics versus non-Hispanic whites. Results Hispanics experienced lower adjusted rates of deceased donor kidney transplantation than non-Hispanic whites (HRCS, 0.77; 95% confidence interval [95% CI], 0.75 to 0.80) measured from dialysis initiation. No meaningful differences were found in time from dialysis initiation to placement on the transplant waitlist. Once waitlisted, Hispanics had lower adjusted rates of deceased donor kidney transplantation (HRCS, 0.66; 95%CI, 0.64 to 0.68), and the association attenuated once accounting for competing risks (HRSD, 0.79; 95%CI, 0.77 to 0.81). Additionally controlling for blood type and organ procurement organization further reduced the disparity (HRSD, 0.99; 95% CI, 0.96 to 1.02). Conclusions After accounting for geographic location and controlling for competing risks (e.g., Hispanic survival advantage), the disparity in access to deceased donor transplantationwas markedly attenuated amongHispanics compared with non-Hispanic whites. To overcome the geographic disparities that Hispanics encounter in the path to transplantation, organ allocation policy revisions are needed to improve donor organ equity.

Original languageEnglish (US)
Pages (from-to)2149-2157
Number of pages9
JournalClinical Journal of the American Society of Nephrology
Volume8
Issue number12
DOIs
StatePublished - Dec 6 2013

ASJC Scopus subject areas

  • Epidemiology
  • Critical Care and Intensive Care Medicine
  • Nephrology
  • Transplantation

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