A. C. Perez-Ortiz1,2, N. Elias1 1Massachusetts General Hospital,Transplant Center,Boston, MA, USA 2Yale University School Of Public Health,New Haven, CT, USA
Introduction:
The new deceased donors (DD) Kidney Allocation System (KAS) aimed to decrease racial allocation disparity, indirectly improving DD transplant rates (TR) for non-Whites. Three years after implementation, we lack evidence of this specific efficacy. We here assess whether the waitlisting and transplant rates across races/ethnicities have improved after KAS implementation.
Methods:
To assess any systematic difference in US TR (1989-2017) and the effect pre- (1989-2014) and post-KAS (2015-2017), we calculated the slope per year basis with data from the Organ Procurement and Transplantation Network database. We then, using regression modeling, estimated the effect of race/ethnicity on kidney waitlist addition and TR across periods adjusting for meaningful covariates. To eliminate improved deceased donation rates effect, we compared kidney to liver TR; a difference indicates a positive impact of KAS. Finally, we similarly evaluated the slope of change for kidney waitlist additions.
Results:
We show three distinct periods wherein the kidney TR varied for all ethnicities. Between 1989–2006 and 2015–2017, there was a significant positive slope -growth of TR on a yearly basis- (β=456.5, and 913.7, respectively), higher in the latter (p<0.02). However, between 2006–2014 there was no change in TR (β=1.6, p<0.01). Furthermore, compared to DD liver TR after KAS implementation (2015-2017), DD kidney TR increased up to 76% (p=0.02). Before 2015, there were no differences between the two groups (p>0.20). Moreover, kidney TR have steadily risen for non-Whites compared to Whites (p=0.03) (Figure). KAS implementation increased the rate for non-Whites ~12-fold (β=344.8, SE=169.4) compared to Whites (β=28.4, SE=45.3) (p = 0.04). Lastly, this improvement was not mirrored in the waitlist additions, and KAS did not change the slope (p=0.25).
Conclusion:
We have preliminary evidence that KAS has improved TR especially benefiting non-Whites (Blacks, Hispanics, and Asians). This improvement is independent of organ donation rates in the same era. Waitlist addition did not equally change, arguing for the need for improved education and other means to alter referral and listing practice.?
