TY - JOUR
T1 - Impact of the new kidney allocation system A2/A2B → B policy on access to transplantation among minority candidates
AU - Martins, Paulo N.
AU - Mustian, Margaux N.
AU - MacLennan, Paul A.
AU - Ortiz, Jorge A.
AU - Akoad, Mohamed
AU - Caicedo, Juan Carlos
AU - Echeverri, Gabriel J.
AU - Gray, Stephen H.
AU - Lopez-Soler, Reynold I.
AU - Gunasekaran, Ganesh
AU - Kelly, Beau
AU - Mobley, Constance M.
AU - Black, Sylvester M.
AU - Esquivel, Carlos
AU - Locke, Jayme E.
N1 - Funding Information:
NIH-National Research Service Award, Grant/Award Number: Grant Award Number T32 DK007545.
Funding Information:
This project was supported by the National Institutes of Health (NIH) – National Research Service Award, through Grant Award Number T32 DK007545. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. The data reported here have been supplied by the Minneapolis Medical Research Foundation (MMRF) as the contractor for the Scientific Registry of Transplant Recipients (SRTR). The interpretation and reporting of these data are the responsibility of the author(s) and in no way should be seen as an official policy of or interpretation by the SRTR or the US Government. This work was also supported in part by Health Resources and Services Administration contract 234-2005-37011C. The content is the responsibility of the authors alone and does not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the US Government. This work was also supported by the American Society of Transplant Surgeons (ASTS) Diversity Affairs Committee. The authors would like to thank Mrs. Ellie Proffit and the ASTS for their support of committee activities.
Publisher Copyright:
© 2018 The American Society of Transplantation and the American Society of Transplant Surgeons
PY - 2018/8
Y1 - 2018/8
N2 - Blood group B candidates, many of whom represent ethnic minorities, have historically had diminished access to deceased donor kidney transplantation (DDKT). The new national kidney allocation system (KAS) preferentially allocates blood group A2/A2B deceased donor kidneys to B recipients to address this ethnic and blood group disparity. No study has yet examined the impact of KAS on A2 incompatible (A2i) DDKT for blood group B recipients overall or among minorities. A case-control study of adult blood group B DDKT recipients from 2013 to 2017 was performed, as reported to the Scientific Registry of Transplant Recipients. Cases were defined as recipients of A2/A2B kidneys, whereas controls were all remaining recipients of non-A2/A2B kidneys. A2i DDKT trends were compared from the pre-KAS (1/1/2013-12/3/2014) to the post-KAS period (12/4/2014-2/28/2017) using multivariable logistic regression. Post-KAS, there was a 4.9-fold increase in the likelihood of A2i DDKT, compared to the pre-KAS period (odds ratio [OR] 4.92, 95% confidence interval [CI] 3.67-6.60). However, compared to whites, there was no difference in the likelihood of A2i DDKT among minorities post-KAS. Although KAS resulted in increasing A2/A2B→B DDKT, the likelihood of A2i DDKT among minorities, relative to whites, was not improved. Further discussion regarding A2/A2B→B policy revisions aiming to improve DDKT access for minorities is warranted.
AB - Blood group B candidates, many of whom represent ethnic minorities, have historically had diminished access to deceased donor kidney transplantation (DDKT). The new national kidney allocation system (KAS) preferentially allocates blood group A2/A2B deceased donor kidneys to B recipients to address this ethnic and blood group disparity. No study has yet examined the impact of KAS on A2 incompatible (A2i) DDKT for blood group B recipients overall or among minorities. A case-control study of adult blood group B DDKT recipients from 2013 to 2017 was performed, as reported to the Scientific Registry of Transplant Recipients. Cases were defined as recipients of A2/A2B kidneys, whereas controls were all remaining recipients of non-A2/A2B kidneys. A2i DDKT trends were compared from the pre-KAS (1/1/2013-12/3/2014) to the post-KAS period (12/4/2014-2/28/2017) using multivariable logistic regression. Post-KAS, there was a 4.9-fold increase in the likelihood of A2i DDKT, compared to the pre-KAS period (odds ratio [OR] 4.92, 95% confidence interval [CI] 3.67-6.60). However, compared to whites, there was no difference in the likelihood of A2i DDKT among minorities post-KAS. Although KAS resulted in increasing A2/A2B→B DDKT, the likelihood of A2i DDKT among minorities, relative to whites, was not improved. Further discussion regarding A2/A2B→B policy revisions aiming to improve DDKT access for minorities is warranted.
KW - disparities
KW - ethics and public policy
KW - ethnicity/race
KW - health services and outcomes research
KW - kidney transplantation/nephrology
KW - organ procurement and allocation
UR - http://www.scopus.com/inward/record.url?scp=85044613897&partnerID=8YFLogxK
U2 - 10.1111/ajt.14719
DO - 10.1111/ajt.14719
M3 - Article
C2 - 29509285
AN - SCOPUS:85044613897
VL - 18
SP - 1947
EP - 1953
JO - American Journal of Transplantation
JF - American Journal of Transplantation
SN - 1600-6135
IS - 8
ER -