Better Outcomes with HHD versus Peritoneal Transplant Trends for Black and White Patients: Deceased and Living

The rates of deceased-donor kidney transplants for black patients have risen in recent years, but racial differences in living-donor transplants persist, according to a research letter in JAMA Internal Medicine.

Using data from the United Network for Organ Sharing, the researchers analyzed trends in kidney transplantation for all recipients and for those with deceased and living donors. The analysis focused on patterns of racial disparity, using the race-stratified incidence of ESRD as the denominator, rather than patients on the transplant waiting list.

From 1998 to 2011, kidney transplantation was performed in 13.5 percent of patients with ESRD in the United States. Of these recipients, 37.1 percent had a living donor. In black patients, the incidence of kidney transplantation increased by 2.8 percent per year. By 2010, there was no difference in the incidence of kidney transplantation for black versus white patients.

For white patients, transplantation from deceased donors declined, whereas living-donor transplants remained stable. In contrast, for black patients, transplants from deceased donors rose by 3.49 percent per year, whereas living-donor transplants were unchanged. Throughout the period studied, 15.5 percent of live kidney donations were from black donors.

Deceased donor transplants for black patients with ESRD have increased since the late 1990s. The authors ascribe this finding to changes in organ allocation eliminating priority points for HLA-B matching.

However, black patients continue to have lower rates of living kidney donors. The authors discuss the implications for efforts to increase rates of living-donor kidney transplantation [Sood A, et al. Rates of kidney transplantation from living and deceased donors for blacks and whites in the United States, 1998 to 2011. JAMA Intern Med 2015 Aug 31. DOI:10.1001/jamainternmed.2015.4530].