Differences in Racial and Ethnic Disparities Between First and Repeat Kidney Transplantation

Shaifali Sandal; JiYoon Ahn; Yusi Chen; Valerie Thompson; Tanjala S Purnell; Marcelo Cantarovich; Maya N Clark-Cutaia; Wenbo Wu; Rita Suri; Dorry L Segev; Mara McAdams-DeMarco

doi:10.1097/TP.0000000000005051

Differences in Racial and Ethnic Disparities Between First and Repeat Kidney Transplantation

Transplantation. 2024 May 21. doi: 10.1097/TP.0000000000005051. Online ahead of print.

Authors

Shaifali Sandal^{1

2

3}, JiYoon Ahn⁴, Yusi Chen⁵, Valerie Thompson⁴, Tanjala S Purnell^{4

5}, Marcelo Cantarovich^{1

2}, Maya N Clark-Cutaia⁶, Wenbo Wu⁷, Rita Suri^{1

2

3}, Dorry L Segev^{5

7}, Mara McAdams-DeMarco^{5

7}

Affiliations

¹ Division of Nephrology, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada.
² Department of Medicine, Research Institute of the McGill University Health Centre, Montreal, QC, Canada.
³ Division of Experimental Medicine, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada.
⁴ Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
⁵ Department of Surgery, NYU Grossman School of Medicine and Langone Health, New York, NY.
⁶ New York University Rory Meyers College of Nursing, New York, NY.
⁷ Department of Population Health, NYU Grossman School of Medicine and Langone Health, New York, NY.

PMID: 38771099
DOI: 10.1097/TP.0000000000005051

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] = 0.77; 95% confidence interval [CI], 0.74-0.80) and receiving re-KT (aHR = 0.61; 95% CI, 0.58-0.64) was greater than the racial/ethnic disparities in first KT (waitlisting: aHR = 0.91; 95% CI, 0.90-0.93; Pinteraction = 0.001; KT: aHR = 0.68; 95% CI, 0.64-0.72; Pinteraction < 0.001). For Hispanic patients, ethnic disparities in waitlisting for re-KT (aHR = 0.83; 95% CI, 0.79-0.88) were greater than for first KT (aHR = 1.14; 95% CI, 1.11-1.16; Pinteraction < 0.001). However, the disparity in receiving re-KT (aHR = 0.76; 95% CI, 0.72-0.80) was similar to that for first KT (aHR = 0.73; 95% CI, 0.68-0.79; Pinteraction = 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.

Abstract

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