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Racial Disparities Seen in Kidney Transplant for Highly Sensitized

WEDNESDAY, April 3, 2019 -- After implementation of the Kidney Allocation System, there was less access to kidney transplant in the black population among patients who are highly sensitized, according to a study published online April 3 in JAMA Surgery.

Sanjay Kulkarni, M.D., from the Yale School of Medicine in New Haven, Connecticut, and colleagues constructed a multistate model from the Organ Procurement and Transplantation Network kidney transplant database. The authors determined the difference in activity status changes among races/ethnicities and levels of sensitization as well as their correlation with outcomes for 42,558 patients on the wait list following Kidney Allocation System implementation.

The researchers found that transplant probability did not differ among races/ethnicities for patients in the calculated plasma reactive antibody category of 0 or 1 to 79 percent. Compared with black individuals, whites had an advantage in transplant probability in calculated plasma reactive antibody categories of 80 to 89 percent and 90 percent or higher (hazard ratios, 1.8 and 2.4, respectively); Hispanics had an advantage over blacks in the calculated plasma reactive antibody category of 90 percent or higher (hazard ratio, 2.5). White individuals were more likely than Hispanic and black individuals to resolve issues resulting in a change from inactive to active status on the wait list (hazard ratios, 1.2 and 1.4, respectively).

"We urge the monitoring of status changes as a quality measure for transplant centers and dialysis providers to encourage care coordination of shared patients, particularly in underserved populations," the authors write.

One author disclosed financial ties to Alexion Pharmaceuticals, which funded the study.

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Posted: April 2019

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