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 - 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
SN - 1600-6135
VL - 18
SP - 1947
EP - 1953
JO - American Journal of Transplantation
JF - American Journal of Transplantation
IS - 8
ER -