Disparities in Kidney Transplant Outcomes: A Review

Abstract

Sociocultural and socioeconomic disparities in graft survival, graft function, and patient survival in adult kidney transplant recipients are reviewed. Studies consistently document worse outcomes for black patients, patients with low income, and less education, whereas better outcomes are reported in Hispanic and Asian kidney transplant recipients. However, the distinct roles of racial/ethnic versus socioeconomic factors remain unclear. Attention to potential pathways contributing to disparities has been limited to immunological and nonimmunological factors, for which the mechanisms have yet to be fully illuminated. Interventions to reduce disparities have focused on modifying immunosuppressant regimens. Modifying access to care and health care funding policies for immunosuppressive medication coverage are also discussed. The implementation of culturally sensitive approaches to the care of transplant candidates and recipients is promising. Future research is needed to examine the mechanisms contributing to disparities in graft survival and to ultimately intervene effectively.

Early Changes in Kidney Distribution under the New Allocation System

“…Disparities in access to organ transplantation (with regards to demographics, ABO/HLA compatibility, sensitization, and other characteristics) persist, [10][11][12] and organ allocation policy is an appropriate tool to address these disparities. However, allocation policy changes alone cannot solve the problem of …”

Living Donor Kidney Transplantation

“…Different patterns of racial and ethnic disparities in kidney transplantation suggest that some minorities, relative to non-Hispanic white patients, may experience more kidney transplant access barriers, be more likely to have initiated dialysis at the time of transplant referral, wait longer for a deceased donor transplant, have higher mortality rates on the waiting list, and have less optimal transplant outcomes (4,6,(13)(14)(15)(16)(17)(18)(19). Because the proportion of patients on the kidney transplant waiting list is increasing for racial/ethnic minorities (while declining for nonHispanic whites) (1), the extreme shortage of deceased donor kidneys is likely to exacerbate these transplant disparities in the years ahead.…”

O papel global do transplante renal

“…6 African American kidney transplant recipients have shorter graft survival compared to Asian, Hispanic, and White populations in the USA. 7 In New Zealand, Maori and Pacific Island recipients of deceased donor transplants have a 50% eight-year graft survival compared to 14 years for non-indigenous recipients, in part due to differences in mortality. 8 By contrast, despite a poor resource environment, Rizvi et al report one and five-year survival rates of 92 and 85%, respectively, among 2,249 living related kidney transplants in Pakistan, 9 whilst in Mexico, 90 and 80% one-year survival for living and deceased donor kidney transplants were reported among 1,356 transplants performed at a single centre.…”

“…22 Multiple immunologic and non-immunologic factors contribute to social, cultural, and economic disparities in transplant outcomes, including biological, immune, genetic, metabolic, and pharmacological factors as well as associated comorbidities, time on dialysis, donor and organ characteristics, patient socioeconomic status, medication adherence, access to care, and public health policies. 23 Developing countries often have especially poor transplant rates not only because of these multiple interacting factors, but also because of the inferior infrastructure and an insufficient trained workforce. Deceased donation rates may also be impacted by lack of a legal framework governing brain death and by religious, cultural, and social constraints.…”