Impact of OPTN policy 3.7D providing waiting time modification for candidates affected by race-inclusive eGFR calculations: Early results from a single center.

INTRODUCTION: OPTN Policy 3.7D, implemented January 5, 2023, mandates that all kidney transplant programs modify waiting time for candidates affected by race-inclusive eGFR calculations. We report the early impact of this policy change. METHODS: Our transplant program reviewed all listed transplant candidates and identified patients potentially eligible for waiting time modification. Eligible candidates received waiting time modification after submission of supporting evidence to the OPTN. We reviewed the impact on waiting time and transplant activity through October 1, 2023. RESULTS: Forty-six adult patients on our center's active waiting list self-identified as Black/African American. 25 (54.3%) candidates qualified for waiting time modification. A median 451 (321, 1543.5) additional days of waiting time was added for qualifying patients. Of the 25 patients who qualified for waiting time modification, 11 patients received a deceased donor kidney in the early period following waiting time modification, including 5 patients transplanted within 1 month after modification. CONCLUSIONS: Policy 3.7D is one of few national mandates to address specifically structural racism within transplantation. Implementation has yielded near immediate effects with greater than 40% of time-adjusted patients at our center receiving a deceased donor kidney transplant in the initial months after policy enactment. Early assessment demonstrates great potential impact for this policy.

Gender differences in authorship among Hepato-pancreatico-biliary surgeons.

BACKGROUND: While studies have explored the gender gap in scientific publications, no study has investigated surgical literature in much detail. We examined the gender gap in Hepato-pancreato-biliary publications over the last decade. METHODS: All physician authored original clinical science articles published in HPB, Annals of Surgery, Surgery, Annals of Surgical Oncology, and JAMA Surgery were reviewed from 2008 to 2017. Chi square analysis was used to compare the proportions of female and male authors and Cochrane-Armitage test was used for comparisons over time. RESULTS: Of the 1067 publications, 84.0% of all authorships were held by men. Women physicians made up 10.3% of senior and 21.4% of first authorships with increased representation from 2.13% in 2007 to 14.8% in 2017 (p = 0.001). Women physicians comprised 14.1% of senior authors in JAMA Surgery, but only 2.46% in Annals of Surgical Oncology. Male authors were five times more likely to publish multiple articles compared to their female counterparts. Female first authors progressed to senior authors at a rate of 1.13% versus 5.73% for male authors (p = 0.89). CONCLUSION: These findings elucidate the continued underrepresentation of women in senior research roles and the need to recruit and mentor women in all stages of their academic careers.

Gender Differences in Authorship Among Transplant Physicians: Are We Bridging the Gap?

BACKGROUND: Despite an increase in the number of practicing female physicians, gender disparities in academic medicine persist. For investigating gender gap in the transplantation field, this study examined the relationship between gender and authorship among medical and surgical transplant physicians. MATERIALS AND METHODS: In this observational study, all original clinical science articles published in the journals of Transplantation, American Journal of Transplantation, and Clinical Transplantation were reviewed from January 2008 to December 2017. Chi-square analysis was used to compare the proportions of female and male authors, and the Cochrane-Armitage test was used for comparisons over time. RESULTS: A total of 2530 publications and 2988 individual authors met the inclusion criteria for the study. Male physicians published significantly more articles compared to female physicians as first (67.4% versus 30.4%) and senior authors (82.9% versus 16.2%), respectively. There were increases in the proportion of female first and senior authors between 2008 and 2017. The majority of authors with multiple publications were male (73.6%), specifically male medical physicians (44.3%). Male medical physicians were the most productive in publication amount and authorship positions. CONCLUSIONS: While research activity among female physicians increased over time, gender disparity continues to exist among female and male physicians in the transplantation field. Academic activity is lower among females in publication amount and authorship positions. These trends emphasize the need to identify barriers to female physician academic productivity within the transplantation field.

The impact of multi-organ transplant allocation priority on waitlisted kidney transplant candidates.

Kidney-alone transplant (KAT) candidates may be disadvantaged by the allocation priority given to multi-organ transplant (MOT) candidates. This study identified potential KAT candidates not receiving a given kidney offer due to its allocation for MOT. Using the Organ Procurement and Transplant Network (OPTN) database, we identified deceased donors from 2002 to 2017 who had one kidney allocated for MOT and the other kidney allocated for KAT or simultaneous pancreas-kidney transplant (SPK) (n = 7,378). Potential transplant recipient data were used to identify the "next-sequential KAT candidate" who would have received a given kidney offer had it not been allocated to a higher prioritized MOT candidate. In this analysis, next-sequential KAT candidates were younger (p < .001), more likely to be racial/ethnic minorities (p < .001), and more highly sensitized than MOT recipients (p < .001). A total of 2,113 (28.6%) next-sequential KAT candidates subsequently either died or were removed from the waiting list without receiving a transplant. In a multivariable model, despite adjacent position on the kidney match-run, mortality risk was significantly higher for next-sequential KAT candidates compared to KAT/SPK recipients (hazard ratio 1.55, 95% confidence interval 1.44, 1.66). These results highlight implications of MOT allocation prioritization, and potential consequences to KAT candidates prioritized below MOT candidates.