Despite interventions during the last 2 decades aimed at reducing the racial and ethnic barriers for patients pursuing live kidney donation, a study recently published in JAMA shows live kidney donation remains elusive for many patients.

However, the authors, along with those of an accompanying editorial, note the disparities of live donor kidney transplant (LDKT) could be narrowed with improved access among minority groups to education about donation and improved payment coverage for living donor expenses, the high cost of which may discourage some from considering kidney donation.

In the study, researchers from the Johns Hopkins Hospital, Duke University School of Medicine and the Feinberg School of Medicine at the University of Chicago, reviewed the records of 453,162 adults who were first-time kidney transplant candidates from 1995 to 1999 and from 2010 to 2014. The aim of the review was to determine whether efforts to reduce racial/ethnic disparities in live donor kidney transplants had changed during those time periods.

White patients received more transplants

However, results showed little change during the decade. White patients received a LDKT within 2 years after appearing on the waiting list and increased from 7% in 1995 to 11.4% in 2014, but transplants decreased from 3.4% to 2.9% among black patients during the same period and decreased from 6.8% to 5.9% among Hispanic patients. Asian patients had more LDKTs during the time periods, increasing from 5.1% to 5.6%.

“These findings suggest that national strategies for addressing disparities in receipt of live donor kidney transplantation should be revisited,” lead author Tanjala S. Purnell, PhD, MPH, from Hopkins, and colleagues wrote. The study received funding from the Agency for Healthcare Research and Policy and from the National Heart, Lung, and Blood Institute.

When looking at all the influential factors, Purnell and colleagues said the disparities were the greatest for black patients and Hispanic patients; those living in poorer (vs. wealthier) neighborhoods; those without (vs. with) a college degree; and those with Medicare (vs. private) insurance.

Approximately one-third of kidney transplants performed in the United States are from living donors, which are associated with improved clinical outcomes and quality of life for patients who are considering transplant. However, the authors noted that disparities have showed up in kidney transplant for years.

“National data since 1988 show that patients from racial/ethnic minority groups are less likely to receive live donor kidney transplantation than white patients, despite having a disproportionately higher burden of end-stage kidney disease,” they wrote.

Potential solutions

Possible solutions to the disparities might include “national dissemination of evidence-based culturally and linguistically appropriate live donor kidney transplantation educational materials, online communities, patient navigation services and policies to standardize and increase the availability of kidney exchanges and chains to help overcome immunological barriers for recipient-donor pairs,” the authors wrote.

“Collaborations among researchers, patient advocates and policy makers are also needed to monitor the effects of legislative efforts on racial/ethnic minorities and to directly target identified barriers to achieving transplantation equity,” they wrote.

In a separate editorial about the study, Colleen L. Jay, MD, MSCI, and Francisco G. Cigarroa, MD, both from the University of Texas Health Science Center, San Antonio, said the disparities could be attributed to a poor access to education and unresolved problems with coverage of costs for the living donor.

In their study, Purnell and colleagues wrote, “Prior studies suggested that racial/ethnic disparities in live donor kidney transplantation may be attributable to barriers encountered at multiple steps along the path to successful live donor kidney transplantation. The steps during which these barriers may be encountered include during referral, identification and pursuit of potential living donors, evaluation and treatment decision-making by the clinician, potential donor and potential recipient.” – Mark E. Neumann

References:
Jay CL, et al. JAMA. 2018;319(1)24-26.
Purnell TS, et al. JAMA. 2018;doi:10.1001/jama.2017.19152.

Disclosures: The authors from both papers reported no relevant financial disclosures.