Racial/ethnic disparities in waitlisting for deceased donor kidney transplantation 1 year after implementation of the new national kidney allocation system

• Published in: American journal of transplantation Vol. 18; no. 8; pp. 1936 - 1946
• Main Authors: Zhang, Xingyu, Melanson, Taylor A., Plantinga, Laura C., Basu, Mohua, Pastan, Stephen O., Mohan, Sumit, Howard, David H., Hockenberry, Jason M., Garber, Michael D., Patzer, Rachel E.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Limited 01.08.2018
• Subjects: Adolescent; Adult; Aged; Cadaver; Cultural differences; Dialysis; Epidemiology; ethics and public policy; Ethnicity - statistics & numerical data; ethnicity/race; Female; Follow-Up Studies; Health Plan Implementation; health services and outcomes research; Healthcare Disparities; Humans; Kidney transplantation; Kidney Transplantation - mortality; kidney transplantation/nephrology; Kidney transplants; Male; Medical ethics; Middle Aged; organ allocation; organ procurement and allocation; Prognosis; Quality of care; quality of care/care delivery; Racial differences; Racial Groups; Registries; Resource Allocation - standards; Survival Rate; Tissue and Organ Procurement - trends; Tissue Donors - supply & distribution; Transplant Recipients; Waiting Lists - mortality; Young Adult; United States > US; epidemiology; ethics and public policy; quality of care/care delivery; kidney transplantation/nephrology; organ procurement and allocation; ethnicity/race; organ allocation; health services and outcomes research
• ISSN: 1600-6135; 1600-6143
• DOI: 10.1111/ajt.14748

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. Following the 2014 change in the kidney allocation system, access to the national deceased donor waiting list declined among patients with less time on dialysis; overall racial disparity reduction was due primarily to a greater proportion of actively waitlisted patients.