Evolving Trends in Racial Disparities for Peri-Operative Outcomes with the New Kidney Allocation System (KAS) Implementation

Overview

Journal J Racial Ethn Health Disparities

Specialties Public Health
Social Sciences

Date 2018 Mar 21

PMID 29557046

Citations 3

Authors

Daisy Sanchez

Derek DuBay

Baliga Prabhakar

David J Taber

Affiliations

Soon will be listed here.

Abstract

Introduction: To improve kidney transplant allocation equitability, a new Kidney Allocation System (KAS) was implemented December 4, 2014. The purpose of this study was to determine if the impact of KAS on peri-operative outcomes differed by recipient race/ethnicity.

Methods: This was a time series analysis using data aggregated in monthly intervals from October 2012 through September 2015 using the University HealthSystem Consortium (UHC). This includes national data aggregated at the center level of all US kidney transplant centers that participate in the UHC (416 centers). Segmented regression with interaction terms was used to determine the impact of KAS on outcomes and differences by race/ethnicity.

Results: A total of 28,809 deceased donor kidney transplants were included with 25 months of pre-KAS data and 10 months of post-KAS data. After KAS implementation, the estimated transplant rate per month decreased significantly for Caucasians by 17.6 cases per month (p = 0.0001), and increased significantly for AAs by 37.8 (p = 0.0001), Hispanics by 16.3 (p = 0.0001), and other races by 8.2 cases per month (p = 0.0001). Delayed graft function, 7- and 14-day readmissions significantly increased after KAS, which did not differ by race. Hispanics saw a 7.7% decrease in ICU admissions after KAS, which differed as compared to other racial/ethnic cohorts (p = 0.0026). Costs of kidney transplantation increased significantly after KAS in all groups except Hispanics. Mortality, length of stay, in-hospital complications, and 30-day readmissions were not significantly impacted by KAS, also not differing by race/ethnicity.

Conclusion: KAS had substantial impact on transplant rates by race/ethnicity. KAS also led to increased costs, readmissions, and delayed graft function (DGF) across all racial/ethnic groups. The impact of KAS on ICU cases solely within Hispanics requires further investigation into potential etiologies.

Citing Articles

Waiting-List and early posttransplant prognosis among ethnoracial groups: Data from the organ procurement and transplantation network.

Wu Y, Lv K, Hao X, Lv C, Lai W, Xia X Front Surg. 2023; 10:1045363.

PMID: 36793312 PMC: 9923172. DOI: 10.3389/fsurg.2023.1045363.

Impact of race on care, readmissions, and survival for patients with glioblastoma: an analysis of the National Cancer Database.

Hodges T, Labak C, Mahajan U, Wright C, Wright J, Cioffi G Neurooncol Adv. 2021; 3(1):vdab040.

PMID: 33959715 PMC: 8086235. DOI: 10.1093/noajnl/vdab040.

Financial impact of delayed graft function in kidney transplantation.

Kim D, Tsapepas D, King K, Ali Husain S, Corvino F, Dillon A Clin Transplant. 2020; 34(10):e14022.

PMID: 32573812 PMC: 8415124. DOI: 10.1111/ctr.14022.

References

Gebel H, Kasiske B, Gustafson S, Pyke J, Shteyn E, Israni A . Allocating Deceased Donor Kidneys to Candidates with High Panel-Reactive Antibodies. Clin J Am Soc Nephrol. 2016; 11(3):505-11. PMC: 4791826. DOI: 10.2215/CJN.07720715. View

Taber D, DuBay D, McGillicuddy J, Nadig S, Bratton C, Chavin K . Impact of the New Kidney Allocation System on Perioperative Outcomes and Costs in Kidney Transplantation. J Am Coll Surg. 2017; 224(4):585-592. PMC: 5368031. DOI: 10.1016/j.jamcollsurg.2016.12.009. View

Sass D, Doyle A . Liver and Kidney Transplantation: A Half-Century Historical Perspective. Med Clin North Am. 2016; 100(3):435-48. DOI: 10.1016/j.mcna.2015.12.001. View

Friedewald J, Samana C, Kasiske B, Israni A, Stewart D, Cherikh W . The kidney allocation system. Surg Clin North Am. 2013; 93(6):1395-406. DOI: 10.1016/j.suc.2013.08.007. View

Filiopoulos V, Boletis J . Renal transplantation with expanded criteria donors: Which is the optimal immunosuppression?. World J Transplant. 2016; 6(1):103-14. PMC: 4801786. DOI: 10.5500/wjt.v6.i1.103. View

Bray R, Brannon P, Breitenbach C, Bryan C, Chen D, Lai J . The new OPTN kidney allocation policy: potential for inequitable access among highly sensitized patients. Am J Transplant. 2014; 15(1):284-5. DOI: 10.1111/ajt.13061. View

Israni A, Salkowski N, Gustafson S, Snyder J, Friedewald J, Formica R . New national allocation policy for deceased donor kidneys in the United States and possible effect on patient outcomes. J Am Soc Nephrol. 2014; 25(8):1842-8. PMC: 4116061. DOI: 10.1681/ASN.2013070784. View

Taber D, McGillicuddy J, Bratton C, Lin A, Chavin K, Baliga P . The concept of a composite perioperative quality index in kidney transplantation. J Am Coll Surg. 2014; 218(4):588-97. DOI: 10.1016/j.jamcollsurg.2013.12.018. View

Ladin K, Hanto D . Rational rationing or discrimination: balancing equity and efficiency considerations in kidney allocation. Am J Transplant. 2011; 11(11):2317-21. PMC: 3203330. DOI: 10.1111/j.1600-6143.2011.03726.x. View

10.

Neylan J, Sayegh M, Coffman T, Danovitch G, Krensky A, Strom T . The allocation of cadaver kidneys for transplantation in the United States: consensus and controversy. ASN Transplant Advisory Group. American Society of Nephrology. J Am Soc Nephrol. 1999; 10(10):2237-43. DOI: 10.1681/ASN.V10102237. View

11.

Smith J, Biggins S, Haselby D, Kim W, Wedd J, Lamb K . Kidney, pancreas and liver allocation and distribution in the United States. Am J Transplant. 2012; 12(12):3191-212. PMC: 3565841. DOI: 10.1111/j.1600-6143.2012.04259.x. View

12.

Chopra B, Sureshkumar K . Changing organ allocation policy for kidney transplantation in the United States. World J Transplant. 2015; 5(2):38-43. PMC: 4478598. DOI: 10.5500/wjt.v5.i2.38. View

13.

Tambur A, Haarberg K, Friedewald J, Leventhal J, Cusick M, Jaramillo A . Unintended Consequences of the New National Kidney Allocation Policy in the United States. Am J Transplant. 2015; 15(9):2465-9. DOI: 10.1111/ajt.13381. View

14.

Stewart D, Kucheryavaya A, Klassen D, Turgeon N, Formica R, Aeder M . Changes in Deceased Donor Kidney Transplantation One Year After KAS Implementation. Am J Transplant. 2016; 16(6):1834-47. DOI: 10.1111/ajt.13770. View

15.

Cho P, Saidi R, Cutie C, Ko D . Competitive Market Analysis of Transplant Centers and Discrepancy of Wait-Listing of Recipients for Kidney Transplantation. Int J Organ Transplant Med. 2015; 6(4):141-9. PMC: 4644566. View

16.

Saunders M, Lee H, Alexander G, Tak H, Thistlethwaite Jr J, Friedman Ross L . Racial disparities in reaching the renal transplant waitlist: is geography as important as race?. Clin Transplant. 2015; 29(6):531-8. PMC: 5088709. DOI: 10.1111/ctr.12547. View

17.

Melanson T, Hockenberry J, Plantinga L, Basu M, Pastan S, Mohan S . New Kidney Allocation System Associated With Increased Rates Of Transplants Among Black And Hispanic Patients. Health Aff (Millwood). 2017; 36(6):1078-1085. PMC: 5681858. DOI: 10.1377/hlthaff.2016.1625. View

18.

Leffell M, Zachary A . The national impact of the 1995 changes to the UNOS renal allocation system. United Network for Organ Sharing. Clin Transplant. 1999; 13(4):287-95. DOI: 10.1034/j.1399-0012.1999.130402.x. View