Transplantation Access and Dialysis Facility Distance

There is no association between the distance between a patient’s residence and a kidney transplant center and access to transplantation. However, according to Adrian Whelan, MBBCh, and colleagues, the distance from the dialysis facility to the transplant center may be an important factor for access to transplantation. Dialysis providers closer to the transplant center may allow for better communication between the two facilities and contribute to expediting of patient work-up.

The researchers conducted a study to test the hypothesis that there would be an association between longer distance from the dialysis facility to the transplant center and longer time to transplantation. Results were reported during a poster session at Kidney Week 2019 in a poster titled Longer Distance from Dialysis Facility to Transplant Center Is Associated with Lower Access to Transplantation.

The study participants were adults who initiated dialysis between 2005 and 2015, as identified in the US Renal Data System database. The primary predictor was distance from the dialysis facility to the transplant center ≥100 miles versus <100 miles (reference group). The outcome of interest was the time from initiation of dialysis to kidney transplantation. The study utilized adjusted Cox models and tested for interactions by region of the United States, calendar year, and dialysis modality.

A total of 172,995 patients were included in the study. Mean age was 51.6 years and 30.3% were black. The distance from the dialysis facility to the transplant center varied by region of the United States. Overall, there was an association between distance from the dialysis facility to the transplant center ≥100 (vs <100 miles) and lower access to transplantation, regardless of dialysis modality. The association was modified by region of the United States and calendar year (P<.05 for interaction).

There was an association between longer distance from the dialysis facility to the transplantation center and lower access to transplant among patients living in the South and the West. The association between distance and transplantation access has attenuated over time.

“Longer dialysis facility to transplant center distance was associated with lower access to kidney transplantation even after accounting for distance between patients and the transplant center. Our data suggest that system-level factors such as proximity between referring and transplant providers may contribute to access to transplantation, but this association varies across the United States,” the researchers said.

Source: Whelan A, Johansen KL, Adey DB, Roll GR, Siyahian S, Ku E. Longer distance from dialysis facility to transplant center is associated with lower access to transplantation. Abstract of a poster presented at the American Society of Nephrology Kidney Week 2019 (Abstract TH-PO1143), November 7, 2019, Washington, DC.