Racial disparities in preemptive referral for kidney transplantation in Georgia

Jennifer C. Gander, Xingyu Zhang, Laura Plantinga, Sudeshna Paul, Mohua Basu, Stephen O. Pastan, Eric Gibney, Erica Hartmann, Laura L Mulloy, Carlos F Zayas Montalvo, Rachel E. Patzer

Research output: Contribution to journalArticle

3 Citations (Scopus)

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.

Original languageEnglish (US)
Article numbere13380
JournalClinical Transplantation
Volume32
Issue number9
DOIs
StatePublished - Sep 1 2018

Fingerprint

Kidney Transplantation
Referral and Consultation
Transplants
African Americans
Living Donors
Kidney
Proportional Hazards Models
Information Systems
Dialysis
Logistic Models

ASJC Scopus subject areas

  • Transplantation

Cite this

Gander, J. C., Zhang, X., Plantinga, L., Paul, S., Basu, M., Pastan, S. O., ... Patzer, R. E. (2018). Racial disparities in preemptive referral for kidney transplantation in Georgia. Clinical Transplantation, 32(9), [e13380]. https://doi.org/10.1111/ctr.13380

Racial disparities in preemptive referral for kidney transplantation in Georgia. / Gander, Jennifer C.; Zhang, Xingyu; Plantinga, Laura; Paul, Sudeshna; Basu, Mohua; Pastan, Stephen O.; Gibney, Eric; Hartmann, Erica; Mulloy, Laura L; Zayas Montalvo, Carlos F; Patzer, Rachel E.

In: Clinical Transplantation, Vol. 32, No. 9, e13380, 01.09.2018.

Research output: Contribution to journalArticle

Gander, JC, Zhang, X, Plantinga, L, Paul, S, Basu, M, Pastan, SO, Gibney, E, Hartmann, E, Mulloy, LL, Zayas Montalvo, CF & Patzer, RE 2018, 'Racial disparities in preemptive referral for kidney transplantation in Georgia', Clinical Transplantation, vol. 32, no. 9, e13380. https://doi.org/10.1111/ctr.13380
Gander JC, Zhang X, Plantinga L, Paul S, Basu M, Pastan SO et al. Racial disparities in preemptive referral for kidney transplantation in Georgia. Clinical Transplantation. 2018 Sep 1;32(9). e13380. https://doi.org/10.1111/ctr.13380
Gander, Jennifer C. ; Zhang, Xingyu ; Plantinga, Laura ; Paul, Sudeshna ; Basu, Mohua ; Pastan, Stephen O. ; Gibney, Eric ; Hartmann, Erica ; Mulloy, Laura L ; Zayas Montalvo, Carlos F ; Patzer, Rachel E. / Racial disparities in preemptive referral for kidney transplantation in Georgia. In: Clinical Transplantation. 2018 ; Vol. 32, No. 9.
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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.",
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AU - Gander, Jennifer C.

AU - Zhang, Xingyu

AU - Plantinga, Laura

AU - Paul, Sudeshna

AU - Basu, Mohua

AU - Pastan, Stephen O.

AU - Gibney, Eric

AU - Hartmann, Erica

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N2 - 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.

AB - 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.

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