Disparities in Access to Valganciclovir Cytomegalovirus Prophylaxis in High-Risk African American Kidney Transplant Patients.

IF 2.6 4区医学 Q3 IMMUNOLOGY

Transplant Infectious Disease Pub Date : 2024-12-18 DOI:10.1111/tid.14416

Shipra R Bethi, David J Taber, Erika Andrade, Zaid M Mesmar, Isabel Calimlim, Courtney E Harris

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引用次数: 0

Abstract

Background: While access and outcomes disparities for African American (AA) kidney transplant recipients are documented, there are limited studies assessing medication access disparities in transplantation. Cytomegalovirus (CMV) causes severe complications for transplant recipients, and we aimed to understand differences in access to CMV prophylaxis valganciclovir and its impact on CMV infection rates in AA transplant recipients.

Methods: This single-center, retrospective longitudinal cohort study examined high-risk (CMV serostatus D+/R-) adult kidney transplant recipients between June 1, 2010, and May 31, 202, through EMR abstraction. Standard univariate comparative statistics were employed alongside binary logistic regression for multivariable modeling.

Results: During the 10 year period, 418 kidney transplant recipients were included, with 179 (42.8%) identified as AA and 239 as non-AA. There were significant differences in mean age (p = 0.001) and private versus Medicaid insurance status (p < 0.001). AAs experienced higher death-censored graft loss rates (10.6% AA vs. 5.0% non-AA, p = 0.031). CMV infection rate, opportunistic infection rate, leukopenia incidence, and death did not differ significantly between AA and non-AA patients. AA patients were 42% less likely to receive valganciclovir out-of-pocket cost assistance compared to non-AA patients (OR 0.58, [0.379-0.892], p = 0.013). When incorporating age, Medicaid status, and donor marginality in a multivariable model, the impact of AA race on utilizing assistance programs became statistically non-significant (OR 0.70, [0.448-1.094], p = 0.118).

Conclusions: AAs were significantly less likely to leverage assistance programs or utilize personal resources to access valganciclovir. This disparity was partially explained by age, insurance status, and donor type. Despite this, CMV infection rates were similar between AA and non-AA cohorts.

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高危非裔美国人肾移植患者获得缬更昔洛韦巨细胞病毒预防的差异

背景：虽然非裔美国人（AA）肾移植受者的可及性和结果差异有文献记载，但评估移植中药物可及性差异的研究有限。巨细胞病毒（CMV）对移植受者造成严重的并发症，我们旨在了解获得巨细胞病毒预防药物缬更昔洛韦的差异及其对AA移植受者巨细胞病毒感染率的影响。方法：这项单中心、回顾性纵向队列研究对2010年6月1日至2020年5月31日期间高危（CMV血清状态D+/R-）成人肾移植受者进行了EMR抽查。标准单变量比较统计与二元逻辑回归一起用于多变量建模。结果：10年间纳入肾移植受者418例，其中AA 179例（42.8%），非AA 239例。在平均年龄（p = 0.001）和私人与医疗补助保险状态（p < 0.001）方面存在显著差异。AA组有较高的死亡切除移植物丧失率（10.6% AA组比5.0%非AA组，p = 0.031）。巨细胞病毒感染率、机会性感染率、白细胞减少发生率和死亡率在AA和非AA患者之间无显著差异。与非AA患者相比，AA患者接受缬更昔洛韦自付费用援助的可能性低42% （OR 0.58, [0.379-0.892], p = 0.013）。当在多变量模型中纳入年龄、医疗补助状况和供体边际性时，AA种族对援助计划利用的影响在统计上不显著（OR 0.70, [0.448-1.094], p = 0.118）。结论：AAs明显不太可能利用援助计划或利用个人资源获得缬更昔洛韦。造成这种差异的部分原因是年龄、保险状况和捐赠者类型。尽管如此，AA组和非AA组的巨细胞病毒感染率相似。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Transplant Infectious Disease 医学-传染病学

CiteScore

5.30

自引率

7.70%

发文量

210

审稿时长

4-8 weeks

期刊介绍： Transplant Infectious Disease has been established as a forum for presenting the most current information on the prevention and treatment of infection complicating organ and bone marrow transplantation. The point of view of the journal is that infection and allograft rejection (or graft-versus-host disease) are closely intertwined, and that advances in one area will have immediate consequences on the other. The interaction of the transplant recipient with potential microbial invaders, the impact of immunosuppressive strategies on this interaction, and the effects of cytokines, growth factors, and chemokines liberated during the course of infections, rejection, or graft-versus-host disease are central to the interests and mission of this journal. Transplant Infectious Disease is aimed at disseminating the latest information relevant to the infectious disease complications of transplantation to clinicians and scientists involved in bone marrow, kidney, liver, heart, lung, intestinal, and pancreatic transplantation. The infectious disease consequences and concerns regarding innovative transplant strategies, from novel immunosuppressive agents to xenotransplantation, are very much a concern of this journal. In addition, this journal feels a particular responsibility to inform primary care practitioners in the community, who increasingly are sharing the responsibility for the care of these patients, of the special considerations regarding the prevention and treatment of infection in transplant recipients. As exemplified by the international editorial board, articles are sought throughout the world that address both general issues and those of a more restricted geographic import.