Access to Transplantation for Hispanic Americans in Texas

Longstanding cultural and geographical disparities are key contributors to the disproportionately reduced access to kidney transplantation among Hispanic Americans. The cultural disparities are multifactorial; geographic disparities include long distances to transplant centers. Delayed referral to transplant also plays a role.

As reported by A. Padilla during a virtual session at the 2021 American Transplant Congress , the University of Texas Medical Branch, Galveston, Texas, operates multiple clinics across Texas, including in the Rio Grande Valley (RGV), near the Texas-Mexico border. The session was titled Gray on the Border: A Closer Look at the Gap in Access to Kidney Transplantation for Hispanic Americans.

The study cohort included all patients evaluated at the center for kidney transplantation between January 2015 and August 2020. The researchers compiled sociodemographic characteristics, comorbidities, and time between declaration of end-stage kidney disease (ESKD) and evaluation. The data were compared by race/ethnicity and between two clinical sites run by the center. The sites were separated by more than 390 miles and had distinct population demographics: RGV (border) and MC (main campus, inland). The researchers also calculated the proportion of life spent with ESKD prior to evaluation.

A total of 2156 patients were evaluated for kidney transplantation during the study period: RGV, 441; MC, 1723. At both sites, 4% of patients had spent at least 20% of their lives with ESKD prior to transplant evaluation. At the RGV site, a greater proportion were Hispanic compared with the MC site (93% vs 38%, P<.01).

Across both sites, the Hispanic patients were significantly younger at the time of evaluation (51 years vs 56 years; P<.01). The time with ESKD at evaluation was significantly longer at RGV than at the MC site (3.3 years vs 2.7 years; P<.01). The proportion of life spent living with ESKD prior to evaluation was also significantly longer at RGV than at MC (6.9% vs 5.7%, P<.01).

In conclusion, the researchers said, “Previous analyses of access to transplantation have focused on waitlist and transplant characteristics. The study demonstrated significant differences between both clinics at the beginning of the transplant process, the evaluation. These data support the need for continued efforts to create and maintain access to transplantation in at-risk socio-cultural groups such as Hispanic Americans.”

Source: Padilla A, Mujtaba M, Samper-Ternent R, et al. Gray on the border: A closer look at the gap in access to kidney transplantation for Hispanic Americans. Abstract of a presentation at the virtual 2021 American Transplant Congress (Abstract #1272), June 5, 2021.