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The role of minority geographic distribution in waiting time for deceased donor kidney transplantation.

ABSTRACT: In the US, African Americans and other minority groups have longer wait times to deceased donor kidney transplantation than Caucasians. To date, the role of geographic distribution of racial and ethnic groups as a determinant of wait times has not been fully elucidated. Using the Scientific Registry of Transplant Recipients database, all registrants for kidney transplant between 2004 and 2007 (n=126,094) were analyzed from time of waitlisting until nonzero antigen mismatched deceased donor kidney transplant. Nationally, deceased donor transplantation occurred at a lower rate for African Americans (hazard ratio [HR] 0.85, confidence interval [CI] 0.83-0.87), Hispanics (HR 0.68, CI 0.66-0.70), Asians/Pacific Islanders (HR 0.77, CI 0.73-0.80) and Other minority groups (HR 0.74, CI 0.69-0.81) compared to Caucasians. Multivariate modeling for age, gender, cause of end-stage renal disease, ABO type, panel reactive antibody, HLA-DR frequency, expanded criteria donor status and prior kidney donation only partially accounted for this difference. Adjusting for these variables and organ procurement organization of listing, African Americans (HR 1.03, CI 1.00-1.06), Hispanics (HR 1.15, CI 1.10-1.19), Asians/Pacific Islanders (HR 1.36, CI 1.30-1.43) and Other minority groups (HR 1.00, CI 0.92-1.09) were transplanted at similar or higher rates than Caucasians. Our findings show that geographic location of waitlisted candidates is the most important contributor to racial disparities in waiting times for deceased donor kidney transplantation.

SUBMITTER: Vranic GM

PROVIDER: S-EPMC4435953 | biostudies-literature | 2014 Nov

REPOSITORIES: biostudies-literature

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The role of minority geographic distribution in waiting time for deceased donor kidney transplantation.

Vranic G M GM Ma J Z JZ Keith D S DS

American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons 20140825 11

In the US, African Americans and other minority groups have longer wait times to deceased donor kidney transplantation than Caucasians. To date, the role of geographic distribution of racial and ethnic groups as a determinant of wait times has not been fully elucidated. Using the Scientific Registry of Transplant Recipients database, all registrants for kidney transplant between 2004 and 2007 (n=126,094) were analyzed from time of waitlisting until nonzero antigen mismatched deceased donor kidne ...[more]

PMID: 25155169

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Project description:Socioeconomically deprived individuals with renal disease are less likely to receive a live-donor kidney transplant than less-deprived individuals. This qualitative study aimed to identify reasons for the observed socioeconomic disparity in live-donor kidney transplantation.A qualitative study using face-to-face in-depth semistructured interviews.A UK tertiary renal referral hospital and transplant centre.Purposive sampling was used to select deceased-donor transplant recipients from areas of high socioeconomic deprivation (SED) (19 participants), followed by a low SED comparison group (13 participants), aiming for maximum diversity in terms of age, gender, ethnicity, primary renal disease and previous renal replacement therapy.Participants were interviewed following their routine transplant clinic review. Interviews were digitally audio-recorded and transcribed verbatim. Transcripts were coded using NVivo software and analysed using the constant comparison method described in Grounded Theory.Themes common and distinct to each socioeconomic group emerged. 6 themes appeared to distinguish between individuals from areas of high and low SED. 4 themes were distinct to participants from areas of high SED: (1) Passivity, (2) Disempowerment, (3) Lack of social support and (4) Short-term focus. 2 themes were distinct to the low SED group: (1) Financial concerns and (2) Location of donor.Several of the emerging themes from the high SED individuals relate to an individual's lack of confidence and skill in managing their health and healthcare; themes that are in keeping with low levels of patient activation. Inadequate empowerment of socioeconomically deprived individuals by healthcare practitioners was also described. Financial concerns did not emerge as a barrier from interviews with the high SED group. Interventions aiming to redress the observed socioeconomic inequity should be targeted at both patients and clinical teams to increase empowerment and ensure shared decision-making.

Dataset Information

The role of minority geographic distribution in waiting time for deceased donor kidney transplantation.

Publications

The role of minority geographic distribution in waiting time for deceased donor kidney transplantation.

Similar Datasets

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