Ability to travel increases access to kidney transplantation, improves long-term survival
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Ability to travel increases a kidney transplant candidate’s access to kidney transplantation and improves the patient’s long-term survival, according to data published in the American Journal of Transplantation.
Further, those who travel for kidney transplantation tend to be white and live in an area with a low poverty rate.
“The purpose of this study was to identify factors associated with ‘traveling’ for a kidney transplant, and to describe the impact of traveling for kidney transplant on waitlist and post-transplant outcomes,” Katherine Ross-Driscoll, PhD, MPH, from Emory University School of Medicine in Atlanta, and colleagues wrote.
Researchers evaluated 194,303 adult kidney-only transplant candidates living in the U.S. between Dec. 5, 2014, and Dec. 31, 2020. All candidate data were derived from the Scientific Registry of Transplant Recipients.
Candidates were assigned to a transplant center based on the transplant referral region (TRR) that included the ZIP code of their home. Researchers created three categories of traveling regarding how far patients had to travel beyond their TRR: (1) no travel, (2) travel to a neighboring TRR and (3) travel beyond neighboring TRRs.
The travel category for post-transplant outcomes was assigned based on the center where patients received their transplant.
Researchers used a directed acyclic graph to determine potential cofounders, such as gender, race, ethnicity, education, primary payer and neighborhood income. Additionally, researchers calculated hazard rations for waitlist and post-transplant outcomes.
Overall, 20.9% of candidates traveled to a neighboring TRR and 5.6% traveled beyond neighboring TRRs. Analyses revealed traveling to a neighboring TRR correlated with a 7% increase in likelihood of deceased donor transplantation, whereas traveling beyond neighboring TRRs correlated with a 19% increase. Most candidates who traveled to a neighboring TRR were white, had some college education and lived in ZIP codes with lower poverty rates. While travelers had similar rates of living donor transplant and waitlist mortality as non-travelers, those who traveled beyond neighboring TTRs had slightly lower mortality after transplant.
“In conclusion, we found that patients who traveled outside of their home TRR had higher deceased donor kidney transplant rates than those who stayed in their home TRR, particularly for patients who traveled beyond their neighboring TRRs,” Ross-Driscoll and colleagues wrote. They added, “Key remaining questions include whether the patient who traveled outside of their local TRR increased wait times for transplant candidates at their destination or displaced organs for this population, and how updated allocation systems, such as continuous distribution, may impact travel in the future.”
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