While black and Hispanic patients are now receiving almost an equal number of deceased donor kidney transplants as white patients, they still face disparities when it come to gaining active status on the transplant list.
According to a recent study published in JAMA, researchers set out to determine the impact of the new Kidney Allocation System launched in 2014. That system was aimed at increasing transplant rates in individuals who are highly sensitized—or had an immune system more likely to reject transplantation—and to improve access to underserved populations.
Looking at information from the Organ Procurement and Transplantation Network, a database that covers the entire country, they found that black and Hispanic patients were less likely to be considered active, or eligible, for a transplant than white patients if they were "highly sensitized."
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Inactive patients on the kidney transplant waitlist have a higher mortality rate.
“It is important to know that inactive patients on the waitlist cannot receive deceased donor organ offers, yet they are counted for when calculated transplant rates," Sanjay Kulkarni, M.D., a researcher at the Yale School of Medicine and a study co-author, told FierceHealthcare. "We showed that blacks and Hispanics experience inactive status more frequently than whites and once made inactive have a lower chance of becoming active. We believe that activity status represents a new marker for measuring health disparities for waitlisted patients.”
However, Hispanic patients had an advantage over black individuals. These differences were mostly due to transplant status, as white patients who were highly sensitized were more likely to move to the active group than black patients. Kulkarni was surprised that Hispanics showed improved transplant rates across the board in the study. While the population has similar issues when it comes to access to healthcare—for unknown reasons—this did not affect their transplant rate.
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Kulkarni and his co-authors conclude that if black individuals continue to have a lower probability of transplant from high calculated panel reactive antibody levels—or the level of an antibody produced by the immune system in response to a foreign body—their mortality will likely be higher than other races or ethnicities.
Most patients are on the waitlist for between five and seven years before getting a transplant, and the key to getting on this waitlist boils down to access to healthcare. Further study of the root causes of ongoing racial disparities in patients who are highly sensitized is needed to guide changes to the allocation system.
“We shouldn’t be surprised that those from underserved populations have less resources, which translates into being made inactive more frequently and longer,” Kulkarni said. “The key is to focus on these patients and improve care coordination between dialysis units and transplant centers to resolve issues of inactivity.”