Racial/ethnic disparities in waitlisting for deceased donor kidney transplantation 1 year after implementation of the new national kidney allocation system.
Am J Transplant
; 18(8): 1936-1946, 2018 08.
Article
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| MEDLINE
| ID: mdl-29603644
ABSTRACT
The impact of a new national kidney allocation system (KAS) on access to the national deceased-donor waiting list (waitlisting) and racial/ethnic disparities in waitlisting among US end-stage renal disease (ESRD) patients is unknown. We examined waitlisting pre- and post-KAS among incident (N = 1 253 100) and prevalent (N = 1 556 954) ESRD patients from the United States Renal Data System database (2005-2015) using multivariable time-dependent Cox and interrupted time-series models. The adjusted waitlisting rate among incident patients was 9% lower post-KAS (hazard ratio [HR] 0.91; 95% confidence interval [CI], 0.90-0.93), although preemptive waitlisting increased from 30.2% to 35.1% (P < .0001). The waitlisting decrease is largely due to a decline in inactively waitlisted patients. Pre-KAS, blacks had a 19% lower waitlisting rate vs whites (HR 0.81; 95% CI, 0.80-0.82); following KAS, disparity declined to 12% (HR 0.88; 95% CI, 0.85-0.90). In adjusted time-series analyses of prevalent patients, waitlisting rates declined by 3.45/10 000 per month post-KAS (P < .001), resulting in ≈146 fewer waitlisting events/month. Shorter dialysis vintage was associated with greater decreases in waitlisting post-KAS (P < .001). Racial disparity reduction was due in part to a steeper decline in inactive waitlisting among minorities and a greater proportion of actively waitlisted minority patients. Waitlisting and racial disparity in waitlisting declined post-KAS; however, disparity remains.
Palabras clave
Texto completo:
1
Base de datos:
MEDLINE
Asunto principal:
Donantes de Tejidos
/
Obtención de Tejidos y Órganos
/
Etnicidad
/
Listas de Espera
/
Trasplante de Riñón
/
Asignación de Recursos
/
Disparidades en Atención de Salud
/
Implementación de Plan de Salud
Tipo de estudio:
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
/
Sysrev_observational_studies
Idioma:
En
Revista:
Am J Transplant
Asunto de la revista:
TRANSPLANTE
Año:
2018
Tipo del documento:
Article