Geographic location may help explain why Hispanics face disparities in kidney transplantation

Hispanics tend to have difficult-to-match blood types and to live in regions with limited organs for transplantation

2013-10-11

(Press-News.org) Washington, DC (October 10, 2013) — In the United States, Hispanics with kidney failure are less likely than non-Hispanic whites to receive a kidney transplant largely due to their blood type and because of where they live, according to a study appearing in an upcoming issue of the Clinical Journal of the American Society of Nephrology (CJASN). The findings highlight the need to implement new deceased donor organ allocation policies that distribute organs over wider geographic areas to help reduce barriers to transplantation for Hispanics.

Hispanics represent the largest minority group in the United States and have an increased risk for developing kidney failure compared with non-Hispanic whites. Prior studies have shown that Hispanics were less likely to be placed on the transplant waiting list, experienced longer waiting times, or were less likely to receive a kidney transplant compared with non-Hispanic whites. Cristina Maria Arce, MD (now at The Ohio State University Wexner Medical Center) and her former colleagues at Stanford University School of Medicine sought to study these issues further by analyzing data from the US Renal Data System, the national registry of individuals with kidney failure. The investigators identified 417,801 Caucasians who initiated dialysis from 1995 to 2007 and were followed through 2008.

Among the major findings: Hispanics were just as likely as non-Hispanic whites to be put on the kidney transplant waitlist. Once waitlisted, Hispanics were 21% less likely to receive a transplant from a deceased donor. But this disparity was largely explained by differences in patient blood type and regional variability of organ supply among organ procurement organizations across the country.

"The main barriers after placement on the waitlist include the tendency for Hispanics to reside in regions with organ procurement organizations characterized by longer median waiting times as well as the higher likelihood for Hispanics to have blood type O, which further complicates organ allocations due to fewer ABO-compatible deceased donors," explained Dr. Arce. "To overcome the geographic disparities that Hispanics encounter in the path to transplantation, organ allocation policy revisions are needed to improve donor organ equity."

### Highlights Hispanics were just as likely as non-Hispanic whites to be put on the kidney transplant waitlist. Once waitlisted, Hispanics were less likely to receive a transplant from a deceased donor. This disparity was largely explained by differences in patient blood type and regional variability of organ supply among organ procurement organizations across the country.

More than 70,000 Americans are placed on the waitlist for a kidney transplant, but fewer than 18,000 receive a transplant per year.

Study co-authors include Benjamin A. Goldstein, PhD, Aya A. Mitani, Colin R. Lenihan, and Wolfgang C. Winkelmayer, MD, ScD.

Disclosures: Wolfgang Winkelmayer reports having served as a scientific advisor or consultant to Affymax, Amgen, Bayer, Fibrogen, and GlaxoSmithKline.

The article, entitled "Differences in Access to Kidney Transplantation between Hispanic and non-Hispanic Whites by Geographic Location in the United States," will appear online at http://cjasn.asnjournals.org/ on October 10, 2013, doi: 10.2215/CJN01560213.

The content of this article does not reflect the views or opinions of The American Society of Nephrology (ASN). Responsibility for the information and views expressed therein lies entirely with the author(s). ASN does not offer medical advice. All content in ASN publications is for informational purposes only, and is not intended to cover all possible uses, directions, precautions, drug interactions, or adverse effects. This content should not be used during a medical emergency or for the diagnosis or treatment of any medical condition. Please consult your doctor or other qualified health care provider if you have any questions about a medical condition, or before taking any drug, changing your diet or commencing or discontinuing any course of treatment. Do not ignore or delay obtaining professional medical advice because of information accessed through ASN. Call 911 or your doctor for all medical emergencies.

Founded in 1966, and with more than 14,000 members, the American Society of Nephrology (ASN) leads the fight against kidney disease by educating health professionals, sharing new knowledge, advancing research, and advocating the highest quality care for patients.

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