Z. Sandhu1, A. Roberts2, H. Kwon3, Z. Leasau3, Z. Sarwar4, O. Andacoglu5 1University of Oklahoma – Tulsa, Internal Medicine, Tulsa, OK, USA 2University Of Oklahoma College Of Medicine, Department Of Surgery, Oklahoma City, OK, USA 3University Of Oklahoma College Of Medicine, Oklahoma City, OK, USA 4University Of Oklahoma College Of Medicine, Division Of Epidemiology And Biostatistics, Department Of Surgery, Oklahoma City, OK, USA 5University Of Oklahoma College Of Medicine, Division Of Transplantation, Department Of Surgery, Oklahoma City, OK, USA
Introduction:
There is no analysis evaluating the relationship between Medicaid expansion and kidney transplants in Oklahoma.
Methods:
The UNOS database (2003-12/2021) was utilized to extract data on adult kidney only transplant recipients in Oklahoma across the pre- and post-Medicaid eras. Bivariate analysis was performed, p-value <0.05 determined statistical significance.
Results:
There were 2849 pre- and 54 post-Medicaid expansion kidney transplant recipients. Post-expansion recipients were more likely to be non-White (50.1% vs. 37.5%)/Hispanic (16.7% vs. 7.20%) and younger (46.5 vs. 54) (all p<0.05). Patients also had better functional scores at transplant/follow up and increased rate of EPTS ≥20% (50.0% vs. 24.9%) (all p<0.05). More HCV NAT+ donor kidneys were utilized (6.70% vs. 1.10%) (<0.0001). There were more regional (18.5% vs 4.1%) and national (46.3% vs 8.1%) organ shares, with resultant longer cold ischemic time (12.8 vs. 12.1hrs), while waitlist time was shorter (225.5 vs 400 days) (all p<0.05). Gender, transplant diagnosis, history of previous kidney transplant, HLA mismatch, KDPI, graft type (living vs deceased), graft parameters and recipient insurance were similar in both eras. Graft and patient survival were not analyzed due to recent change in policy (7/2021).
Conclusion:
Medicaid expansion in Oklahoma was not associated with higher transplantation of recipients with public insurance. The post-expansion era does correlate with increased proportion of kidney transplants for non-White/Hispanic patients and younger recipients. HCV donor organs had increased utilization in the post-expansion timeframe. Ongoing research is necessary to determine the long-term relationship between Medicaid expansion, patient demographics, and patient/graft survival.
