Access to Living Donor KT in Minority Communities

Racial disparities in living donor kidney transplantation are increasing. There are associations between living in linguistically isolated communities or in areas with large minority populations and decreased access to transplant. Living donor kidney transplant recipient/donor pairs are 95% racially concordant. There are few data available on the contemporary relationship between access to living donor kidney transplantation in communities with high minority and in less English-proficient populations.

Alixandra C. Killian, MD, MPH, and colleagues conducted an analysis to examine access to living donor transplants in such communities. Results of the analysis were reported during an oral session at the virtual ASN Kidney Week 2021. The presentation was titled Living in High Minority, Less English-Proficient Communities May Facilitate Living Donor Kidney Transplantation among Asian Americans and Pacific Islanders.

The analysis utilized the Scientific Registry of Transplant Recipients to identify adult, kidney-0only transplant recipients from January 1, 2018, to December 31, 2018. Recipients’ zip codes were matched to the Minority Status and Language Theme of the Centers for Disease Control and Prevention 2018 Social Vulnerability Index. The likelihood of living donor kidney transplantation was evaluated using modified Poisson regression.

The study included data on 18,950 kidney transplant recipients; of those 32% received a living donor transplant. Black (adjusted relative risk [aRR], 0.60; 95% confidence interval [CI], 0.49-0.74) and Asian American and Pacific Islander (AAPI) recipients (aRR, 0.52; 95% CI, 0.39-0.70) were less likely to receive a kidney from a living donor compared with White recipients.

Overall, there was no association between community minority status and language proficiency and living donor kidney transplantation (aRR, 1.01; 95% CI, 1.00-1.02); however, the effect of this vulnerability measure varied by race. Among AAPI recipients only, there was an association between living in higher minority, less English-proficient communities and increased likelihood of receiving a kidney from a living donor (ratio of aRR, 1.66; 95% CI, 1.12-2.47).

In summary, the authors said, “While all minority recipients had lower likelihood of living donor kidney transplantation, living in higher minority, less English-proficient communities may be paradoxically advantageous for AAPI patients. Given living donor kidney transplantation racial concordance, living in areas with shared culture or language may facilitate living donor kidney transplantation access among AAPI.”

Source: Killian AC, Shelton BA, MacLennan PA, et al. Living in high minority, less English-proficient communities may facilitate living donor kidney transplantation among Asian Americans and Pacific Islanders. Abstract of an oral presentation at the American Society of Nephrology virtual Kidney Week 2021 (Abstract TH-OR58), November 4, 2021.