Broad organ acceptance and equitable access to early kidney transplantation

Nikolas H Zaphiros; Jing Nie; Shirley Chang; Vaqar Shah; Samer Kareem; Ahmad Zaaroura; Liise K Kayler

doi:10.1111/ctr.14916

Broad organ acceptance and equitable access to early kidney transplantation

Clin Transplant. 2023 Apr;37(4):e14916. doi: 10.1111/ctr.14916. Epub 2023 Jan 28.

Authors

Nikolas H Zaphiros^{1

2}, Jing Nie³, Shirley Chang^{2

4}, Vaqar Shah^{2

4}, Samer Kareem^{2

4}, Ahmad Zaaroura^{1

2}, Liise K Kayler^{1

2

5}

Affiliations

¹ Department of Surgery, University at Buffalo, Buffalo, New York, USA.
² Transplant and Kidney Care Regional Center of Excellence, Erie County Medical Center, Buffalo, New York, USA.
³ Department of Epidemiology and Environmental Health, University at Buffalo School of Public Health and Health Professions, Buffalo, New York, USA.
⁴ Department of Medicine, University at Buffalo, Buffalo, New York, USA.
⁵ Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, Buffalo, New York, USA.

PMID: 36638138
DOI: 10.1111/ctr.14916

Abstract

Background: Broad organ acceptance can increase early kidney transplantation (KTX) within <1-year of dialysis initiation while improving access inequity.

Methods: Single-center data of adult isolated deceased-donor KTX recipients between 2013 and 2020 were stratified into three 2.5-year periods before-, early after-, and late after our center's deceased-donor organ acceptance practice change, excluding a 6-month implementation period. Outcomes were assessed within five recipient subgroups based on demographic and clinical characteristics.

Results: Of 704 recipients, the frequency of early KTX was 22% pre-change, 36% early post-change, and 34% late post-change. Given similar post-change frequencies of early KTX, post-change eras were combined to improve analytic power of subgroup analyses. After the organ acceptance practice change (vs. pre-change), the likelihood of early KTX increased variably within historically underserved groups, including recipients who were older (37%-39%, p = .859), Black (10%-21%, p = .136), female (21%-37%, p = .034), diabetic (13%-32%, p = .010), and BMI≥35 kg/m² (20%-34%, p = .007). Despite the practice change, Black recipients continued to experience less early KTX compared to non-Black recipients. The likelihood of delayed graft function was significantly increased (p < .001), and 1-year creatinine was significantly higher (p < .001) post-practice change, but between-era risk-adjusted death-censored graft survival was similar.

Conclusions: Transition to broader donor acceptance was associated with more early KTXs among historically underserved patient subgroups. However, the effect was non-significant among Black recipients, suggesting the need for additional strategies to impact early transplant access for this population. Studies of broad organ acceptance are needed to examine both access and outcomes.

Keywords: access; dialysis duration; dialysis vintage; disparity; graft survival; kidney transplant; organ acceptance criteria.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Female
Graft Survival
Humans
Kidney Transplantation*
Renal Dialysis
Retrospective Studies
Tissue Donors
Transplants*
Treatment Outcome