Racial Disparities Worsen for Live Donor Kidney Transplants (CME/CE) | IUK Med Online
Friday, June 22, 2018
Home Diseases & Conditions Racial Disparities Worsen for Live Donor Kidney Transplants (CME/CE)

Racial Disparities Worsen for Live Donor Kidney Transplants (CME/CE)

91
0
SHARE


Medpage Today

Racial Disparities Worsen for Live Donor Kidney Transplants

Fewer blacks, Hispanics get transplant now than two decades ago

MedpageToday

  • register today

    Earn Free CME Credits by reading the latest medical news in your specialty.

    sign up

  • by Contributing Writer, MedPage Today
  • This article is a collaboration between MedPage Today® and:

    Medpage Today

Action Points

  • Racial and ethnic disparities in live donor kidney transplants have increased during the past two decades, according to national registry data, suggesting that strategies to reduce these disparities haven’t worked.
  • Note that approximately one-third of kidney transplants in the US are live donor transplants, which are associated with better outcomes than are deceased donor transplants or long-term dialysis for patients with end-stage renal disease.

Racial and ethnic disparities in live donor kidney transplants have increased during the past two decades, suggesting that strategies to reduce these disparities haven’t worked, investigators said.

From 1995 to 2014, live donor transplants among first-time candidates on the waiting list increased from 7% to 11% for whites, but they decreased from 3.4% to 2.9% among blacks and from 6.8% to 5.9% among Hispanics. For Asian patients, there was a slight increase from 5.1% to 5.6%, said Tanjala Purnell, PhD, of the Johns Hopkins School of Medicine in Baltimore, and colleagues.

In 1995-1999, black patients were 55% less likely to receive a live-donor transplant compared with white patients (HR 0.45; 95% CI 0.42-0.48). Hispanic patients were 17% less likely (HR 0.83; 95% CI 0.77-0.88), and Asian patients were 44% less likely (HR 0.56; 95% CI 0.50-0.63; P<0.001 for all comparisons), Purnell’s group reported in the Journal of the American Medical Association.

In 2010-2014, the likelihood of a live donor transplant dwindled even further for non-white patients. Blacks were 73% less likely to receive one compared with whites (HR 0.27; 95% CI 0.26-0.28), Hispanics were 48% less likely (HR 0.52; 95% CI 0.50-0.54), and Asians were 58% less likely (HR 0.42; 95% CI 0.39-0.45; P<0.001 for all comparisons).

Approximately one-third of kidney transplants performed in the United States are live donor transplants. Live donor transplants are associated with better outcomes for patients with end-stage renal disease than deceased donor transplants or long-term dialysis, Purnell and colleagues said.

Previous studies have reported racial and ethnic disparities in live donor kidney transplantation. Interventions have been implemented over the past two decades at the single-center and multi-center levels to address barriers to live donor transplants, which include financial disincentives, lack of health insurance and access to healthcare, and less knowledge about transplantation, Purnell’s group said.

“Findings from this study suggest that current efforts to reduce live donor kidney transplantation disparities need to be revisited, perhaps with a national strategy initiative,” the study authors said. “Although center-level patient engagement strategies are important for removing disincentives to live donor kidney transplantation, the implementation of national, evidence-based strategies to address live donor kidney transplantation disparities would likely be more effective.”

Potential national strategies could include culturally and linguistically appropriate educational materials, online communities, patient navigation services, and policies that standardize and increase the availability of kidney exchanges, they said.

“Collaborations among researchers, patient advocates, and policy makers are also needed to monitor the effects of legislative efforts on racial/ethnic minorities and to directly target identified barriers to achieving transplantation equity,” they said.

Purnell’s group analyzed data on more than 450,000 adult kidney transplant candidates in the Scientific Registry of Transplant Recipients. This registry includes data on all donors, candidates, and transplantation recipients in the United States that are submitted by the members of the Organ Procurement and Transplantation Network.

The study authors examined data from 1995 through 2014. They used multivariable Cox proportional hazards and competing risk models to look for relationships between race/ethnicity and live donor kidney transplants.

In an accompanying editorial, Colleen Jay, MD, and Francisco Cigarroa, MD, both of the University of Texas Health Science Center in San Antonio, said prior studies have shown that socioeconomic factors, including poverty and lack of education and health insurance, are the root causes of the disparities reported by Purnell’s group and others.

“Differences in socioeconomic factors remain pervasive for many black and Hispanic patients in the United States. Differences in socioeconomic factors can touch all aspects involved in finding and undergoing a live donor kidney transplantation, including early education and access to healthcare and transplantation; clustering of medical risk factors that can preclude safe donation such as obesity, diabetes, and hypertension; and financial disincentives for individuals considering live donation,” Jay and Cigarroa said.

The biggest barrier may be the financial disincentives faced by kidney donors, they said. More than half of donors incur more than $1,000 in out-of-pocket costs, and 20% of donors incur more than $5,000. These costs include direct costs such as travel and health care expenses as well as indirect costs such as lost wages, they said.

An important limitation of the study was that it could not assess whether potential racial and ethnic differences in preferences about live donor transplants could be part of the reason for the observed disparities, the study authors said.

The study was funded by the Agency for Healthcare Research and Quality and the National Institutes of Health.

The study authors disclosed no conflicts of interest.

Jay and Cigarroa disclosed no conflicts of interest.

2018-01-05T13:00:00-0500
Take Posttest Comments

Accessibility Statement

At MedPage Today, we are committed to ensuring that individuals with disabilities can access all of the content offered by MedPage Today through our website and other properties. If you are having trouble accessing www.medpagetoday.com, MedPageToday's mobile apps, please email legal@ziffdavis.com for assistance. Please put "ADA Inquiry" in the subject line of your email.

Medpage Today

Racial Disparities Worsen for Live Donor Kidney Transplants

Fewer blacks, Hispanics get transplant now than two decades ago

MedpageToday

  • register today

    Earn Free CME Credits by reading the latest medical news in your specialty.

    sign up

  • by Contributing Writer, MedPage Today
  • This article is a collaboration between MedPage Today® and:

    Medpage Today

Action Points

  • Racial and ethnic disparities in live donor kidney transplants have increased during the past two decades, according to national registry data, suggesting that strategies to reduce these disparities haven't worked.
  • Note that approximately one-third of kidney transplants in the US are live donor transplants, which are associated with better outcomes than are deceased donor transplants or long-term dialysis for patients with end-stage renal disease.

Racial and ethnic disparities in live donor kidney transplants have increased during the past two decades, suggesting that strategies to reduce these disparities haven't worked, investigators said.

From 1995 to 2014, live donor transplants among first-time candidates on the waiting list increased from 7% to 11% for whites, but they decreased from 3.4% to 2.9% among blacks and from 6.8% to 5.9% among Hispanics. For Asian patients, there was a slight increase from 5.1% to 5.6%, said Tanjala Purnell, PhD, of the Johns Hopkins School of Medicine in Baltimore, and colleagues.

In 1995-1999, black patients were 55% less likely to receive a live-donor transplant compared with white patients (HR 0.45; 95% CI 0.42-0.48). Hispanic patients were 17% less likely (HR 0.83; 95% CI 0.77-0.88), and Asian patients were 44% less likely (HR 0.56; 95% CI 0.50-0.63; P<0.001 for all comparisons), Purnell's group reported in the Journal of the American Medical Association.

In 2010-2014, the likelihood of a live donor transplant dwindled even further for non-white patients. Blacks were 73% less likely to receive one compared with whites (HR 0.27; 95% CI 0.26-0.28), Hispanics were 48% less likely (HR 0.52; 95% CI 0.50-0.54), and Asians were 58% less likely (HR 0.42; 95% CI 0.39-0.45; P<0.001 for all comparisons).

Approximately one-third of kidney transplants performed in the United States are live donor transplants. Live donor transplants are associated with better outcomes for patients with end-stage renal disease than deceased donor transplants or long-term dialysis, Purnell and colleagues said.

Previous studies have reported racial and ethnic disparities in live donor kidney transplantation. Interventions have been implemented over the past two decades at the single-center and multi-center levels to address barriers to live donor transplants, which include financial disincentives, lack of health insurance and access to healthcare, and less knowledge about transplantation, Purnell's group said.

"Findings from this study suggest that current efforts to reduce live donor kidney transplantation disparities need to be revisited, perhaps with a national strategy initiative," the study authors said. "Although center-level patient engagement strategies are important for removing disincentives to live donor kidney transplantation, the implementation of national, evidence-based strategies to address live donor kidney transplantation disparities would likely be more effective."

Potential national strategies could include culturally and linguistically appropriate educational materials, online communities, patient navigation services, and policies that standardize and increase the availability of kidney exchanges, they said.

"Collaborations among researchers, patient advocates, and policy makers are also needed to monitor the effects of legislative efforts on racial/ethnic minorities and to directly target identified barriers to achieving transplantation equity," they said.

Purnell's group analyzed data on more than 450,000 adult kidney transplant candidates in the Scientific Registry of Transplant Recipients. This registry includes data on all donors, candidates, and transplantation recipients in the United States that are submitted by the members of the Organ Procurement and Transplantation Network.

The study authors examined data from 1995 through 2014. They used multivariable Cox proportional hazards and competing risk models to look for relationships between race/ethnicity and live donor kidney transplants.

In an accompanying editorial, Colleen Jay, MD, and Francisco Cigarroa, MD, both of the University of Texas Health Science Center in San Antonio, said prior studies have shown that socioeconomic factors, including poverty and lack of education and health insurance, are the root causes of the disparities reported by Purnell's group and others.

"Differences in socioeconomic factors remain pervasive for many black and Hispanic patients in the United States. Differences in socioeconomic factors can touch all aspects involved in finding and undergoing a live donor kidney transplantation, including early education and access to healthcare and transplantation; clustering of medical risk factors that can preclude safe donation such as obesity, diabetes, and hypertension; and financial disincentives for individuals considering live donation," Jay and Cigarroa said.

The biggest barrier may be the financial disincentives faced by kidney donors, they said. More than half of donors incur more than $1,000 in out-of-pocket costs, and 20% of donors incur more than $5,000. These costs include direct costs such as travel and health care expenses as well as indirect costs such as lost wages, they said.

An important limitation of the study was that it could not assess whether potential racial and ethnic differences in preferences about live donor transplants could be part of the reason for the observed disparities, the study authors said.

The study was funded by the Agency for Healthcare Research and Quality and the National Institutes of Health.

The study authors disclosed no conflicts of interest.

Jay and Cigarroa disclosed no conflicts of interest.

2018-01-05T13:00:00-0500
Take Posttest Comments

Accessibility Statement

At MedPage Today, we are committed to ensuring that individuals with disabilities can access all of the content offered by MedPage Today through our website and other properties. If you are having trouble accessing www.medpagetoday.com, MedPageToday's mobile apps, please email legal@ziffdavis.com for assistance. Please put "ADA Inquiry" in the subject line of your email.



Source link

LEAVE A REPLY

Please enter your comment!
Please enter your name here