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Racial, ethnic disparities continue among live donor kidney transplant recipients

Racial and ethnic disparities increased from 1995 to 2014 among first-time kidney transplant candidates on the deceased donor waiting list who went on to receive a live donor kidney transplant, according to findings recently published in JAMA.

“Over the last 2 decades, dozens of interventions addressing racial/ethnic disparities in live donor kidney transplantation have been developed and implemented in single-center and small multicenter environments,” Tanjala S. Purnell, PhD, MPH, of the John Hopkins Center for Health Equity, and colleagues wrote. “The primary goal of this study was to assess whether racial/ethnic disparities in live donor kidney transplantation have narrowed over [that period].”

Researchers conducted a secondary analysis of 453,162 adult patients (mean age, 50.9 years) who were first-time kidney transplant candidates between Jan. 1, 1995, and Dec. 31, 2014. Of that total, 6% were Asian, 16% were Hispanic, 30% were black and 48% were white.

Purnell and colleagues found that in 1995, the cumulative incidence a live donor kidney transplant occurred at 2 years after being put on the waiting list was 5.1% among Asian patients, 6.8% among Hispanics, 3.4% among blacks, and 7% among whites. In 2014, the cumulative incidence was 5.6% among Asian patients, 5.9% in Hispanics, 2.9% among blacks and 11.4% in whites. From 1995-1999 to 2010-2014, ethnic/racial disparities in the receipt of live donor kidney transplant increased between white patients and Asian, Hispanic and black patients (P < .001 for all).

From 1995 to 1999, when compared with white patients, the adjusted subhazard ratios for receipt of live donor kidney transplant were 0.56 (95% CI, 0.5-0.63) among Asian patients, 0.83 (95% CI, 0.77-0.88) among Hispanics, and 0.45 (95% CI, 0.42-0.48) among blacks,. From 2010 to 2014, the same adjusted subhazard ratios were 0.42 (95% CI, 0.39-0.45) among Asian patients, 0.52 (95% CI, 0.5-0.54) among Hispanics, and 0.27 (95% CI, 0.26-0.28) among blacks.

“Findings from this study suggest that current efforts to reduce live donor kidney transplantation disparities need to be revisited,” Purnell and colleagues wrote.

“Potential strategies could include national dissemination of evidence-based culturally and linguistically appropriate live donor kidney transplantation educational materials, online communities, patient navigation services and policies to standardize and increase the availability of kidney exchanges and chains to help overcome immunological barriers for recipient donor pairs. 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 added.

In a related editorial, Colleen L. Jay, MD, MSCI, and Francisco G. Cigarroa MD, both of the University of Texas Health Science Center, wrote that some of the disparities are likely due to quality of health care; inequities in health insurance coverage; and higher rates of metabolic syndrome, hypertension, diabetes and obesity among certain minority groups that preclude some of their population from becoming kidney donors.

“Perhaps the most obvious barrier to improvements in rates of live donor kidney transplantation relates to the financial disincentives faced by kidney donors,” they wrote. “Factors related to lower socioeconomic status and current economic pressures stand strikingly at the forefront of barriers to improving these disparities. Efforts to improve financial neutrality for living donors may in fact also contribute greatly to mitigating disparities still existing according to race/ethnicity.” – by Janel Miller

Disclosure: The authors report no relevant financial disclosures.