Journal
AMERICAN JOURNAL OF TRANSPLANTATION
Volume 18, Issue 8, Pages 1936-1946Publisher
WILEY
DOI: 10.1111/ajt.14748
Keywords
epidemiology; ethics and public policy; ethnicity; race; health services and outcomes research; kidney transplantation; nephrology; organ allocation; organ procurement and allocation; quality of care; care delivery
Categories
Funding
- National Institute on Minority Health and Health Disparities [R01MD010290]
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The impact of a new national kidney allocation system (KAS) on access to the national deceased-donor waiting list (waitlisting) and racial/ethnic disparities in waitlisting among US end-stage renal disease (ESRD) patients is unknown. We examined waitlisting pre- and post-KAS among incident (N=1253100) and prevalent (N=1556954) ESRD patients from the United States Renal Data System database (2005-2015) using multivariable time-dependent Cox and interrupted time-series models. The adjusted waitlisting rate among incident patients was 9% lower post-KAS (hazard ratio [HR]: 0.91; 95% confidence interval [CI], 0.90-0.93), although preemptive waitlisting increased from 30.2% to 35.1% (P<.0001). The waitlisting decrease is largely due to a decline in inactively waitlisted patients. Pre-KAS, blacks had a 19% lower waitlisting rate vs whites (HR: 0.81; 95% CI, 0.80-0.82); following KAS, disparity declined to 12% (HR: 0.88; 95% CI, 0.85-0.90). In adjusted time-series analyses of prevalent patients, waitlisting rates declined by 3.45/10000 per month post-KAS (P<.001), resulting in approximate to 146 fewer waitlisting events/month. Shorter dialysis vintage was associated with greater decreases in waitlisting post-KAS (P<.001). Racial disparity reduction was due in part to a steeper decline in inactive waitlisting among minorities and a greater proportion of actively waitlisted minority patients. Waitlisting and racial disparity in waitlisting declined post-KAS; however, disparity remains. Following the 2014 change in the kidney allocation system, access to the national deceased donor waiting list declined among patients with less time on dialysis; overall racial disparity reduction was due primarily to a greater proportion of actively waitlisted patients.
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