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Racial disparities in preemptive referral for kidney transplantation in Georgia
Author(s) -
Gander Jennifer C.,
Zhang Xingyu,
Plantinga Laura,
Paul Sudeshna,
Basu Mohua,
Pastan Stephen O.,
Gibney Eric,
Hartmann Erica,
Mulloy Laura,
Zayas Carlos,
Patzer Rachel E.
Publication year - 2018
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/ctr.13380
Subject(s) - medicine , referral , kidney transplantation , dialysis , kidney disease , transplantation , hazard ratio , psychological intervention , african american , logistic regression , united network for organ sharing , odds ratio , odds , demography , gerontology , family medicine , confidence interval , liver transplantation , ethnology , psychiatry , sociology , history
Abstract Background Racial disparities persist in access to kidney transplantation. Racial differences in preemptive referral, or referral prior to dialysis start, may explain this discrepancy. Methods Patient‐level data on kidney transplant referrals (2005‐2012) from all Georgia transplant centers were linked to the United States Renal Data System to examine racial disparities in preemptive referral, waitlisting, and living donor transplant. Adjusted logistic regression and Cox proportional hazard models determined the associations between race (African American vs white) and preemptive referral, and placement on the waitlist and receipt of a living donor kidney, respectively. Results Among 7752 adults referred for transplant evaluation, 20.38% (n = 1580) were preemptively referred. The odds of African Americans being preemptively referred for transplant evaluation were 37% ( OR = 0.63; [95% CI : 0.55 0.71]) lower than white patients. Among preemptively referred patients, there was no racial difference (African Americans compared to white patients. HR = 0.96; [95% CI : 0.88, 1.04]) in waitlisting. However, African Americans were 70% less likely than white patients to receive a living donor transplant ( HR = 0.30; [95% CI : 0.21, 0.42]). Conclusion Racial disparities in transplant receipt may be partially explained by disparities in preemptive referral. Interventions to reduce racial disparities in kidney transplant access may need to be targeted earlier in the disease process.