L.A. Schafrank1, M. Adjei2, S. Wisel2, J. Steggerda2, I. Kim2 1David Geffen School of Medicine at UCLA, Los Angeles, CA, USA 2Cedars Sinai Comprehensive Transplant Center, Transplant Surgery, Los Angeles, CA, USA
Introduction: Racial disparities in access to simultaneous pancreas kidney (SPK) transplantation have been previously documented, attributed to socioeconomic factors and notable differences in disease prevalence amongst races for type 1 diabetes. Recently, extending pancreas transplantation to select patients with type 2 diabetes has gained greater traction in the United States, and potentially offers both SPK and pancreas-after-kidney (PAK) transplantation to a wider racial distribution.
Methods: This is a retrospective study utilizing data provided by United Network for Organ Sharing (UNOS) from 2015 to 2022, a period wherein pancreas transplantation for type 2 diabetes has become more accepted, to assess racial access to both waiting lists for organs and actual pancreas transplantation. A subset of the UNOS KIDPAN file was sub-sectioned and filtered by T1DM and T2DM and then sorted by background characteristics, payment source, wait times, and geographic region of transplant. Wait times were also evaluated across and within regions by race.
Results: The current study, allowing for recent changes in transplantation protocols and practices, includes both type 1 and type 2 diabetic patients in its analysis and compares findings with previously published historical data. Our results show a marked improvement in greater racial equity in access to pancreas transplantation from retrospective studies performed that showed over 90% of recipients being White. Despite greater type 2 disease prevalence in minority patients and an observable improvement in racial equity in pancreatic transplantation from prior studies, it appears that an imbalance still exists between the prevalence of disease requiring transplantation and rates of transplantation based on race, with Whites receiving 52.4% of transplants while representing only 30.7% of diabetic Americans with ESRD. Furthermore, Blacks and Hispanics represented 34.2% and 26.0% respectively of diabetic-related individuals with ESRD in the US population, but only received 10.4 % and 7.2 % of transplanted organs. While protocols that require multiple HLA matching may be part of the reason for this discrepancy, as non-Whites represent a smaller portion of the donor population, recent studies have contradicted the need for complete HLA matching for favorable transplantation outcomes.
Conclusion: The results indicate that opening pancreas transplantation to patients with type 2 diabetes allows greater access to this potentially curative operation for diabetics of minority races, but more work in transplant equity needs to be done.