Racial Ethnic Differences in Rates and Determinants of Deceased Donor Kidney Transplantation

Abstract

Contemporary studies have not comprehensively compared waiting times and determinants of deceased donor kidney transplantation across all major racial ethnic groups in the Unites States. Here, we compared relative rates and determinants of waitlisting and deceased donor kidney transplantation among 503,090 nonelderly adults of different racial ethnic groups who initiated hemodialysis between1995 and 2006 with follow-up through 2008. Annual rates of deceased donor transplantation from the time of dialysis initiation were lowest in American Indians/Alaska Natives (2.4%) and blacks (2.8%), intermediate in Pacific Islanders (3.1%) and Hispanics (3.2%), and highest in whites (5.9%) and Asians (6.4%). Lower rates of deceased donor transplantation among most racial ethnic minority groups appeared primarily to reflect differences in time from waitlisting to transplantation, but this was not the result of higher rates of waitlist inactivity or removal from the waitlist. The fraction of the reduced transplant rates attributable to measured factors (e.g., demographic, clinical, socioeconomic, linguistic, and geographic factors) varied from 14% in blacks to 43% in American Indians/Alaska Natives compared with whites. In conclusion, adjusted rates of deceased donor kidney transplantation remain significantly lower among racial ethnic minorities compared with whites; generally, differences in time to waitlisting were not as pronounced as differences in time between waitlisting and transplantation. Determinants of delays in time to transplantation differed substantially by racial ethnic group. Area-based efforts targeted to address racial-and ethnic-specific delays in transplantation may help to reduce overall disparities in deceased donor kidney transplantation in the United States.

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.…”

The Relationship of Age, Race, and Ethnicity with Survival in Dialysis Patients

“…Although black patients initiate maintenance dialysis at a younger age (4), they are less likely to receive kidney transplants, the treatment of choice in ESRD (8). In addition, when on dialysis, they are less likely to receive arteriovenous fistula placement (9) and adequate dialysis dose (10).…”

Impact of a Patient Education Program on Disparities in Kidney Transplant Evaluation

“…Despite strong evidence for improved quality of life and survival after transplantation, there is a large gap between the number of patients who need a kidney transplant and the number of available organs (2). Racial disparities in access to kidney transplantation have been documented in several steps in the renal transplant process, including referral, evaluation completion, and waitlisting (3)(4)(5)(6)(7)(8)(9). The reasons for the disparities are likely multifactorial, and they may not be entirely explained by clinical factors (10)(11)(12).…”