Under the current US allocation system, non-White transplant candidates are substantially less likely to receive high-longevity, high-quality deceased donor kidneys, reports an article in the American Journal of Kidney Diseases.
The researchers analyzed data on 199,444 adults listed for deceased donor kidney transplantation from 2015 through 2020, drawn from the Scientific Registry of Transplant Recipients. Race and ethnicity were classified as Asian in 7% of patients, Black in 29%, and Hispanic/Latino in 19%. Outcomes of interest were priorities for longevity matching, based on an estimated posttransplant survival (EPTS) of 20% or less, and transplantation with a high-longevity deceased donor kidney, defined by a kidney donor profile index of 20% or less.
The mean age was 52 years for Black and 50 years for Hispanic/Latino candidates compared with 55 years for White patients. White patients were less likely to have diabetes, spent less time on dialysis, and were more likely to have previous transplants.
After adjustment for age, non-White candidates were less likely to have an EPTS score of 20% or less: odds ratio, 0.86 for Asian patients; 0.52 for Black patients; and 0.49 for Hispanic/Latino patients. The same racial and ethnic groups were less likely to receive a high-longevity kidney, based on a kidney donor profile index of 20% or less: subhazard ratio, 0.70 for Asian patients; 0.89 for Black patients; and 0.73 for Hispanic/Latino patients.
Posttransplant mortality was significantly lower for Asian and Hispanic recipients: hazard ratio, 0.45 and 0.63, respectively, compared with White recipients. Posttransplant mortality was higher for Black compared with White patients, although the difference was not statistically significant.
The current allocation system prioritizes the use of high-longevity kidneys for patients with high EPTS scores, which reflect patient age, presence of diabetes, history of transplantation, and time on dialysis. This could potentially disadvantage non-White candidates, who tend to be younger but more likely to have diabetes and longer durations of dialysis. The new study finds that non-White patients are less likely to be prioritized for and to receive high-longevity deceased donor kidneys, after adjustment for age. This is despite the finding that minority recipients of high-longevity kidneys have similar or even better posttransplant outcomes than their White counterparts.
“[O]ur results demonstrate that the current EPTS score is a barrier to equity in kidney transplantation,” the researchers write. They discuss potential strategies for achieving “relatively equal” access to high-quality kidneys across racial and ethnic groups [Asfour N, et al. Association of race and ethnicity with high longevity deceased donor kidney transplantation under the US kidney allocation system. Am J Kidney Dis, published online April 16, 2024. doi: 10.1053/j.ajkd.2024.02.017].
