Study: ‘No improvement’ in racial gaps for living donor kidney transplants for 11 years
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Key takeaways:
- Researchers found “no improvement” in living transplant rates between Black and white adults.
- Black patients made up 33.1% of waitlisted adults but received 14.1% of living transplants.
Racial disparities in living donor kidney transplants have not improved during an 11-year period, however, further study may identify strategies to improve access, according to results of a study.
“Major efforts are needed to better understand the association between transplant centers and [living donor kidney transplants] LDKT racial equity,” Lisa M. McElroy, MD, MS, of the department of surgery at the Duke University School of Medicine in Durham, North Carolina, wrote with colleagues. “We examined racial differences in LDKT rates among U.S. transplant centers in light of differences in waiting list, referral region and center characteristics to identify targets for multilevel interventions.”
Researchers completed a retrospective cohort longitudinal trial in February 2023, which examined data from U.S. transplant centers that performed at least 12 LDKT annually between January 2008 and December 2018.
The study included 57,222 adults who received living transplants, and researchers obtained statistics from the Health Resources Services Administration database, linked to the U.S. Renal Data System and the Scientific Registry of Transplant Recipients. The main outcome of the study was the estimated yearly best-case center-specific living transplant rate ratios between Black and white patients.
Researchers found “no improvement either in the observed or the covariate-adjusted” living transplant rate ratios between Black and white adults during the study period, the authors wrote. Black patients made up 33.1% of waitlisted adults but received 14.1% of living transplants. The final cohorts included 394,625 waitlisted patients: 33.1% were Black and 66.9% were white; and 57,222 living transplant recipients: 14.1% were Black and 85.9% were white.
Center-level factors played a role in the disparities, according to the findings. Among 89 transplant centers, the estimated yearly center-level rate ratios between Black and white patients ranged from 0.0557 in 2008 to 0.771 in 2018.
The yearly median rate ratios scaled from 0.216 in 2016 to 0.285 in 2010, the researchers found. For model-based estimations for the hypothetical best-case scenarios, the study showed little change in the minimum rate ratio and a larger positive shift in the maximum rate ratio. Additionally, relative to the observed 582 living transplants in Black patients and 3,837 in white patients, the hypothetical model estimated an increase of 423 (72.7%) for Black patients and of 1,838 (47.9%) for white patients.
“Our findings observed geographic but no temporal variation and suggest that center participation in national programs, such as the paired exchange and voucher programs, may help to mitigate LDKT race inequities,” McElroy wrote. “Achieving racial equity will require identification of LDKT [rate ratios] related to the referral region conditions, and tailored interventions and goal setting should be based on the center-specific barriers.”
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