Disparities exist in kidney transplant timing

African Americans, individuals without private insurance less likely to receive a transplant before needing dialysis

2013-02-01

(Press-News.org) Highlights African Americans and individuals without private health insurance are less likely to receive a kidney transplant before needing dialysis. Geographic region is not a major factor in determining whether a patient receives a kidney transplant before starting dialysis.

Nearly 90,000 people in the U.S. are waiting for a kidney transplant, and many will die before a suitable organ becomes available.

Washington, DC (January 31, 2013) — African-Americans and individuals without private health insurance are less likely than others to receive a kidney transplant before requiring dialysis, according to a study appearing in an upcoming issue of the Clinical Journal of the American Society of Nephrology (CJASN). The findings indicate that efforts are needed to ensure the equitable distribution of donor kidneys and the timing of transplantation.

While kidney transplantation is the best available therapy for kidney failure, demand for donor kidneys far exceeds the supply. The longer transplant candidates wait while on dialysis, the worse they do after receiving a transplant. In some areas of the country, the average kidney transplant candidate can wait six years on dialysis before receiving a deceased donor organ. Elsewhere, patients can receive transplants preemptively, or before dialysis is even required.

Morgan Grams, MD (Johns Hopkins University School of Medicine) and her colleagues examined information from all adult first-time deceased donor kidney transplant recipients in the US between 1995 and 2011, classifying them as preemptive, early (on dialysis for one year or less), or late recipients.

Among the major findings: Preemptive recipients were 9% of the total recipient population. Patients with private insurance or a previous (nonkidney) transplant were more likely to receive a preemptive deceased donor kidney transplant. African Americans were 66% less likely than Caucasians to receive a preemptive deceased donor kidney transplant. Overall, patients transplanted preemptively had similar survival compared with patients transplanted within one year after initiating dialysis.

"We found that, while some regions performed deceased donor preemptive transplants more than others, region was not a big factor in determining preemptive transplant rates," said Dr. Grams. "Rather, we were struck by the disparities by race and insurance type: African American were much less likely to receive kidney transplantation prior to requiring dialytic support, as were those with public or no insurance," she added.

The authors noted that given the long wait times for deceased donor kidneys and the fairly comparable survival between patients transplanted preemptively and those transplanted within one year after initiating dialysis, the value of preemptive transplantation from a societal standpoint may be low.

### Study co-authors include B. Po-Han Chen, ScM, Josef Coresh, MD, PhD, and Dorry Segev, MD PhD.

Disclosures: The authors reported no financial disclosures.

The article, entitled "Preemptive Deceased Donor Kidney Transplantation: Considerations of Equity and Utility," will appear online at http://cjasn.asnjournals.org/ on January 31, 2013, doi: 10.2215/CJN.05310512.

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 13,500 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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Disparities exist in kidney transplant timing

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