Disparities in Access to Repeat Kidney Transplantation by Age and Race

Due perhaps to improvements in survival among kidney transplant recipients, the incidence of graft failure is increasing. The benefits of repeat kidney transplantation have been well documented. However, according to S.S. Patole and colleagues, there are disparities in access to repeat kidney transplantation.

The researchers conducted a study to examine the trends and disparities in access to repeat transplantation. Results were reported during a virtual session at the 2021 American Transplant Congress in a presentation titled Age and Racial Disparities in Access to Re-kidney Transplantation.

The study utilized data from the United States Renal Data System to identify 93,014 adults patients whose first kidney transplant graft failed between 1995 and 2017. Trends in graft failure over time and outcomes following graft failure were assessed by age, sex, and race. The Kaplan Meier method and adjusted Cox proportional hazards models were used to estimate the chance of listing for repeat kidney transplant, waitlist mortality, and repeat transplant among those who were listed for repeat transplant (n=46,613) by age, sex, and race.

During the study period, there was an increase in the number of graft failures from 2320 in 1995 to 4988 in 2017. The proportions of patients ≥65 years of age with graft failure increased from 5.7%to 27.5% during the study period. Among the population with graft failure, the proportion of Black patients remained stable: 33.5% in 1995 and 31.3% in 2017. The proportion of women was 41.1% in 1995 and 39.9% in 2017.

The chance of being listed for repeat kidney transplant was lower among older patients (adjusted hazard ratio [aHR], 0.37; 95% confidence interval [CI], 0.36-0.39) and Black patients (aHR, 0.79; 95% CI, 0.77-0.81). The risk of waitlist mortality was higher among older patients (aHR, 2.59; 95% CI, 2.40-2.79).

Older patients (aHR, 0.92; 95% CI, 0.85-0.99) and Black patients (aHR, 0.53; 95% CI, 0.50-0.55) were less likely to receive repeat kidney transplantation. There were no differences by sex in listing, waitlist mortality, or repeat kidney transplantation.

In conclusion, the researchers said, “There are age and racial disparities in access to repeat kidney transplantation. Efforts should be made to improve equitable access to repeat kidney transplantation for older and Black patients with graft failure.”

Source: Patole S S, Ahn J, Sandal S, Segev D, McAdams Demarco M. Age and racial disparities in access to re-kidney transplantation. Abstract of a presentation at the virtual 2021 American Transplant Congress (Abstract #285), June 7, 2021.