The role of minority geographic distribution in waiting time for deceased donor kidney transplantation.

In the US, African Americans and other minority groups have longer wait times to deceased donor kidney transplantation than Caucasians. To date, the role of geographic distribution of racial and ethnic groups as a determinant of wait times has not been fully elucidated. Using the Scientific Registry of Transplant Recipients database, all registrants for kidney transplant between 2004 and 2007 (n=126,094) were analyzed from time of waitlisting until nonzero antigen mismatched deceased donor kidney transplant. Nationally, deceased donor transplantation occurred at a lower rate for African Americans (hazard ratio [HR] 0.85, confidence interval [CI] 0.83-0.87), Hispanics (HR 0.68, CI 0.66-0.70), Asians/Pacific Islanders (HR 0.77, CI 0.73-0.80) and Other minority groups (HR 0.74, CI 0.69-0.81) compared to Caucasians. Multivariate modeling for age, gender, cause of end-stage renal disease, ABO type, panel reactive antibody, HLA-DR frequency, expanded criteria donor status and prior kidney donation only partially accounted for this difference. Adjusting for these variables and organ procurement organization of listing, African Americans (HR 1.03, CI 1.00-1.06), Hispanics (HR 1.15, CI 1.10-1.19), Asians/Pacific Islanders (HR 1.36, CI 1.30-1.43) and Other minority groups (HR 1.00, CI 0.92-1.09) were transplanted at similar or higher rates than Caucasians. Our findings show that geographic location of waitlisted candidates is the most important contributor to racial disparities in waiting times for deceased donor kidney transplantation.