Alexandra C Bolognese, Madelaine Hack, Christine Kolwitz, Oren Shaked, Christopher Connelly, David Woodland, C Kristian Enestvedt, David Scott, Ali Olyaei, Erin Maynard
{"title":"Transplant Referral and Long-Term Kidney Allograft Survival for Black Patients: Single-Center Study.","authors":"Alexandra C Bolognese, Madelaine Hack, Christine Kolwitz, Oren Shaked, Christopher Connelly, David Woodland, C Kristian Enestvedt, David Scott, Ali Olyaei, Erin Maynard","doi":"10.1097/XCS.0000000000001395","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Despite improvements in access to transplantation, there remains disparities in all aspects of transplant among minority patients. We sought to examine referral practices and long-term outcomes of kidney transplantation across racial identities at our center.</p><p><strong>Study design: </strong>We conducted a retrospective review of kidney transplantation recipients from January 2010 to May 2024. Data were obtained from United Network for Organ Sharing and confirmed with the electronic medical record. Patients were categorized as White, Black, Asian, Hispanic, Hawaiian/Pacific Islander, and American Indian/Alaska Native.</p><p><strong>Results: </strong>A total of 1,369 patients met criteria with 67% White, 6.9% Black, 7.9% Asian, 14.1% Hispanic, 2.6% Hawaiian/Pacific Islander, and 1.5% American Indian/Alaska Native. There were no significant between group differences in kidney donor profile index, expected posttransplant survival, recipient or donor age or cytomegalovirus status, cold ischemia time, and time from referral to evaluation or listing. There was a significant difference in waiting time for Black compared with White patients (733.6 vs 595.4 days, p = 0.026). Black patients had higher mean creatinine at 6 months and 1 year compared with all others (1.6 vs 1.3 mg/dL at both time points, p < 0.001). After adjusting for baseline characteristics, Black patients had an increased risk of allograft loss at 15 years compared with White patients (p < 0.001) and were to receive a living donor transplant (10.5% vs 25.3%, p < 0.01) or a preemptive kidney transplantation (10.5% vs 27.0%, p < 0.01).</p><p><strong>Conclusions: </strong>Despite disproportionate representation among patients with chronic kidney disease, compared with age-matched White patients, Black patients at our center are referred for transplant later and have a higher rate of 10-year allograft loss. It is up to us to focus on education and close the gap and improve outcomes for all of our transplant recipients.</p>","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"39-47"},"PeriodicalIF":3.8000,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of the American College of Surgeons","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/XCS.0000000000001395","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/6/13 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"SURGERY","Score":null,"Total":0}
引用次数: 0
Abstract
Background: Despite improvements in access to transplantation, there remains disparities in all aspects of transplant among minority patients. We sought to examine referral practices and long-term outcomes of kidney transplantation across racial identities at our center.
Study design: We conducted a retrospective review of kidney transplantation recipients from January 2010 to May 2024. Data were obtained from United Network for Organ Sharing and confirmed with the electronic medical record. Patients were categorized as White, Black, Asian, Hispanic, Hawaiian/Pacific Islander, and American Indian/Alaska Native.
Results: A total of 1,369 patients met criteria with 67% White, 6.9% Black, 7.9% Asian, 14.1% Hispanic, 2.6% Hawaiian/Pacific Islander, and 1.5% American Indian/Alaska Native. There were no significant between group differences in kidney donor profile index, expected posttransplant survival, recipient or donor age or cytomegalovirus status, cold ischemia time, and time from referral to evaluation or listing. There was a significant difference in waiting time for Black compared with White patients (733.6 vs 595.4 days, p = 0.026). Black patients had higher mean creatinine at 6 months and 1 year compared with all others (1.6 vs 1.3 mg/dL at both time points, p < 0.001). After adjusting for baseline characteristics, Black patients had an increased risk of allograft loss at 15 years compared with White patients (p < 0.001) and were to receive a living donor transplant (10.5% vs 25.3%, p < 0.01) or a preemptive kidney transplantation (10.5% vs 27.0%, p < 0.01).
Conclusions: Despite disproportionate representation among patients with chronic kidney disease, compared with age-matched White patients, Black patients at our center are referred for transplant later and have a higher rate of 10-year allograft loss. It is up to us to focus on education and close the gap and improve outcomes for all of our transplant recipients.
期刊介绍:
The Journal of the American College of Surgeons (JACS) is a monthly journal publishing peer-reviewed original contributions on all aspects of surgery. These contributions include, but are not limited to, original clinical studies, review articles, and experimental investigations with clear clinical relevance. In general, case reports are not considered for publication. As the official scientific journal of the American College of Surgeons, JACS has the goal of providing its readership the highest quality rapid retrieval of information relevant to surgeons.