Racial, ethnic disparities persist for patients in receiving kidney transplants from live donors

Bottom Line: Black and Hispanic patients are less likely than white patients to receive a live donor kidney after two years on a waiting list, with an increase in disparity over the last two decades.

Why The Research Is Interesting: Transplantation with a kidney from a live donor is associated with better medical outcomes and quality of life for patients with end-stage kidney disease compared to long-term dialysis treatment or kidney transplantation from a deceased donor. Because racial and ethnic minority patients are known to be less likely than white patients to receive a live donor kidney, dozens of changes have been made to transplant processes over the last 2 decades to reduce the disparities.

Who and When: 453,162 first-time candidates for kidney transplantation between 1995-2014, with follow-up through 2016

What (Study Measures): Race and ethnicity (exposures); time to kidney transplantation from a live donor (outcome)

How (Study Design): A secondary analysis of an observational study using transplant registry data where researchers are not intervening for purposes of the study and cannot control natural differences that could explain the study findings.

Authors: Tanjala S. Purnell, Ph.D., M.P.H., Johns Hopkins School of Medicine, Baltimore, and coauthors.

Results: Racial and ethnic disparities in live donor kidney transplantation increased from 1995 to 2014. Cumulative incidence in the chart below, a measure of the frequency of kidney transplants from live donors after two years on a waiting list, increased for whites and Asians and decreased for Blacks and Hispanics.

Study Limitations: The study could not identify reasons for the disparities, such as patient preference or trends in willingness of live healthy donors to donate kidneys.

Study Conclusions: Existing strategies in place for reducing racial and ethnic disparities in live donor kidney transplantation may not be effective and should be revisited.

Related material: The following related elements also are available on the For The Media website

The editorial, "Disparities in Live Donor Kidney Transplantation," by Colleen L. Jay, M.D., M.S.C.I., and Francisco G. Cigarroa, M.D., University of Texas Health Science Center, San Antonio.

Links to related studies previously published by The JAMA Network:

Implementation of the Affordable Care Act and Solid-Organ Transplantation Listings in the United States

Variation in Dialysis Facility Referral for Kidney Transplantation Among Patients With End-Stage Renal Disease in Georgia

Age-Related Kidney Transplant Outcomes

For more details and to read the full study, please visit the For The Media website.

(doi:10.1001/jama.2017.19152)

Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

Credit: 
JAMA