Differences in Racial and Ethnic Disparities Between First and Repeat Kidney Transplantation.
Transplantation
; 108(10): 2144-2152, 2024 Oct 01.
Article
en En
| MEDLINE
| ID: mdl-38771099
ABSTRACT
BACKGROUND:
Recent data suggest patients with graft failure had better access to repeat kidney transplantation (re-KT) than transplant-naive dialysis accessing first KT. This was postulated to be because of better familiarity with the transplant process and healthcare system; whether this advantage is equitably distributed is not known. We compared the magnitude of racial/ethnic disparities in access to re-KT versus first KT.METHODS:
Using United States Renal Data System, we identified 104 454 White, Black, and Hispanic patients with a history of graft failure from 1995 to 2018, and 2 357 753 transplant-naive dialysis patients. We used adjusted Cox regression to estimate disparities in access to first and re-KT and whether the magnitude of these disparities differed between first and re-KT using a Wald test.RESULTS:
Black patients had inferior access to both waitlisting and receiving first KT and re-KT. However, the racial/ethnic disparities in waitlisting for (adjusted hazard ratio [aHR]â =â 0.77; 95% confidence interval [CI], 0.74-0.80) and receiving re-KT (aHRâ =â 0.61; 95% CI, 0.58-0.64) was greater than the racial/ethnic disparities in first KT (waitlisting aHRâ =â 0.91; 95% CI, 0.90-0.93; Pinteraction = 0.001; KT aHRâ =â 0.68; 95% CI, 0.64-0.72; Pinteraction < 0.001). For Hispanic patients, ethnic disparities in waitlisting for re-KT (aHRâ =â 0.83; 95% CI, 0.79-0.88) were greater than for first KT (aHRâ =â 1.14; 95% CI, 1.11-1.16; Pinteraction â <â 0.001). However, the disparity in receiving re-KT (aHRâ =â 0.76; 95% CI, 0.72-0.80) was similar to that for first KT (aHRâ =â 0.73; 95% CI, 0.68-0.79; Pinteraction â =â 0.55). Inferences were similar when restricting the cohorts to the Kidney Allocation System era.CONCLUSIONS:
Unlike White patients, Black and Hispanic patients with graft failure do not experience improved access to re-KT. This suggests that structural and systemic barriers likely persist for racialized patients accessing re-KT, and systemic changes are needed to achieve transplant equity.
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Reoperación
/
Listas de Espera
/
Trasplante de Riñón
/
Disparidades en Atención de Salud
Límite:
Adult
/
Aged
/
Female
/
Humans
/
Male
/
Middle aged
País/Región como asunto:
America do norte
Idioma:
En
Revista:
Transplantation
Año:
2024
Tipo del documento:
Article
País de afiliación:
Canadá