Distance to Kidney Transplant Center and Access to Early Steps in the Kidney Transplantation Process in the Southeastern United States

Background and objectives Access to kidney transplantation requires a referral to a transplant center for medical evaluation. Prior research suggests that the distance that a person must travel to reach a center might be a barrier to referral. We examined whether a shorter distance from patients’ residence to a transplant center increased the likelihood of referral and initiating the transplant evaluation once referred. Design, setting, participants, & measurements Adults who began treatment for ESKD at any Georgia, North Carolina, or South Carolina dialysis facility from 1/1/2012 to 12/31/2015 were identified from the US Renal Data System. Referral (within 1 year of dialysis initiation) and evaluation initiation (within 6 months of referral) data were collected from all nine transplant centers located in that region. Distance was categorized as 90 miles from the center of a patient’s residential zip code to the nearest center. We used multilevel, multivariable-adjusted logistic regression to quantify the association between distance with referral and evaluation initiation. Results Among 27,250 adult patients on incident dialysis, 9582 (35%) were referred. Among those referred, 58% initiated evaluation. Although patients who lived farther from a center were less likely to be referred, distance was not statistically significantly related to transplant referral: adjusted odds ratios of 1.08 (95% confidence interval, 0.96 to 1.22), 1.07 (95% confidence interval, 0.95 to 1.22), 0.96 (95% confidence interval, 0.84 to 1.10), and 0.87 (95% confidence interval, 0.74 to 1.03) for 15–30, 31–60, 61–90, and >90 miles, respectively, compared with 90 miles, respectively, compared with <15 miles ( P trend =0.70). Conclusions Distance from residence to transplant center among patients undergoing long-term dialysis in the southeastern United States was not associated with increased likelihood of referral and initiating transplant center evaluation.