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Association of Race and Ethnicity With Live Donor Kidney Transplantation in the United States From 1995 to 2014.

Abstract Over the past 2 decades, there has been increased attention and effort to reduce disparities in live donor kidney transplantation (LDKT) for black, Hispanic, and Asian patients with end-stage kidney disease. The goal of this study was to investigate whether these efforts have been successful.
PMID
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Authors

Mayor MeshTerms

Living Donors

Keywords
Journal Title jama
Publication Year Start




PMID- 29297077
OWN - NLM
STAT- MEDLINE
DCOM- 20180110
LR  - 20180110
IS  - 1538-3598 (Electronic)
IS  - 0098-7484 (Linking)
VI  - 319
IP  - 1
DP  - 2018 Jan 2
TI  - Association of Race and Ethnicity With Live Donor Kidney Transplantation in the
      United States From 1995 to 2014.
PG  - 49-61
LID - 10.1001/jama.2017.19152 [doi]
AB  - Importance: Over the past 2 decades, there has been increased attention and
      effort to reduce disparities in live donor kidney transplantation (LDKT) for
      black, Hispanic, and Asian patients with end-stage kidney disease. The goal of
      this study was to investigate whether these efforts have been successful.
      Objective: To estimate changes over time in racial/ethnic disparities in LDKT in 
      the United States, accounting for differences in death and deceased donor kidney 
      transplantation. Design, Setting, and Participants: A secondary analysis of a
      prospectively maintained cohort study conducted in the United States of 453162
      adult first-time kidney transplantation candidates included in the Scientific
      Registry of Transplant Recipients between January 1, 1995, and December 31, 2014,
      with follow-up through December 31, 2016. Exposures: Race/ethnicity. Main
      Outcomes and Measures: The primary study outcome was time to LDKT. Multivariable 
      Cox proportional hazards and competing risk models were constructed to assess
      changes in racial/ethnic disparities in LDKT among adults on the deceased donor
      kidney transplantation waiting list and interaction terms were used to test the
      statistical significance of temporal changes in racial/ethnic differences in
      receipt of LDKT. The adjusted subhazard ratios are estimates derived from the
      multivariable competing risk models. Data were categorized into 5-year increments
      (1995-1999, 2000-2004, 2005-2009, 2010-2014) to allow for an adequate sample size
      in each analytical cell. Results: Among 453162 adult kidney transplantation
      candidates (mean [SD] age, 50.9 [13.1] years; 39% were women; 48% were white;
      30%, black; 16%, Hispanic; and 6%, Asian), 59516 (13.1%) received LDKT. Overall, 
      there were 39509 LDKTs among white patients, 8926 among black patients, 8357
      among Hispanic patients, and 2724 among Asian patients. In 1995, the cumulative
      incidence of LDKT at 2 years after appearing on the waiting list was 7.0% among
      white patients, 3.4% among black patients, 6.8% among Hispanic patients, and 5.1%
      among Asian patients. In 2014, the cumulative incidence of LDKT was 11.4% among
      white patients, 2.9% among black patients, 5.9% among Hispanic patients, and 5.6%
      among Asian patients. From 1995-1999 to 2010-2014, racial/ethnic disparities in
      the receipt of LDKT increased (P < .001 for all statistical interaction terms in 
      adjusted models comparing white patients vs black, Hispanic, and Asian patients).
      In 1995-1999, compared with receipt of LDKT among white patients, the adjusted
      subhazard ratio was 0.45 (95% CI, 0.42-0.48) among black patients, 0.83 (95% CI, 
      0.77-0.88) among Hispanic patients, and 0.56 (95% CI, 0.50-0.63) among Asian
      patients. In 2010-2014, compared with receipt of LDKT among white patients, the
      adjusted subhazard ratio was 0.27 (95% CI, 0.26-0.28) among black patients, 0.52 
      (95% CI, 0.50-0.54) among Hispanic patients, and 0.42 (95% CI, 0.39-0.45) among
      Asian patients. Conclusions and Relevance: Among adult first-time kidney
      transplantation candidates in the United States who were added to the deceased
      donor kidney transplantation waiting list between 1995 and 2014, disparities in
      the receipt of live donor kidney transplantation increased from 1995-1999 to
      2010-2014. These findings suggest that national strategies for addressing
      disparities in receipt of live donor kidney transplantation should be revisited.
FAU - Purnell, Tanjala S
AU  - Purnell TS
AD  - Division of Transplantation, Department of Surgery, Johns Hopkins School of
      Medicine, Baltimore, Maryland.
AD  - Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health,
      Baltimore, Maryland.
AD  - Department of Health Behavior and Society, Johns Hopkins Bloomberg School of
      Public Health, Baltimore, Maryland.
AD  - Johns Hopkins Center for Health Equity, Johns Hopkins University, Baltimore,
      Maryland.
FAU - Luo, Xun
AU  - Luo X
AD  - Division of Transplantation, Department of Surgery, Johns Hopkins School of
      Medicine, Baltimore, Maryland.
FAU - Cooper, Lisa A
AU  - Cooper LA
AD  - Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health,
      Baltimore, Maryland.
AD  - Department of Health Behavior and Society, Johns Hopkins Bloomberg School of
      Public Health, Baltimore, Maryland.
AD  - Johns Hopkins Center for Health Equity, Johns Hopkins University, Baltimore,
      Maryland.
AD  - Division of General Internal Medicine, Johns Hopkins School of Medicine,
      Baltimore, Maryland.
FAU - Massie, Allan B
AU  - Massie AB
AD  - Division of Transplantation, Department of Surgery, Johns Hopkins School of
      Medicine, Baltimore, Maryland.
AD  - Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health,
      Baltimore, Maryland.
FAU - Kucirka, Lauren M
AU  - Kucirka LM
AD  - Division of Transplantation, Department of Surgery, Johns Hopkins School of
      Medicine, Baltimore, Maryland.
AD  - Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health,
      Baltimore, Maryland.
FAU - Henderson, Macey L
AU  - Henderson ML
AD  - Division of Transplantation, Department of Surgery, Johns Hopkins School of
      Medicine, Baltimore, Maryland.
FAU - Gordon, Elisa J
AU  - Gordon EJ
AD  - Department of Surgery, Northwestern University Feinberg School of Medicine,
      Chicago, Illinois.
FAU - Crews, Deidra C
AU  - Crews DC
AD  - Johns Hopkins Center for Health Equity, Johns Hopkins University, Baltimore,
      Maryland.
AD  - Division of Nephrology, Department of Medicine, Johns Hopkins School of Medicine,
      Baltimore, Maryland.
FAU - Boulware, L Ebony
AU  - Boulware LE
AD  - Division of General Internal Medicine, Duke University School of Medicine,
      Durham, North Carolina.
FAU - Segev, Dorry L
AU  - Segev DL
AD  - Division of Transplantation, Department of Surgery, Johns Hopkins School of
      Medicine, Baltimore, Maryland.
AD  - Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health,
      Baltimore, Maryland.
LA  - eng
GR  - K01 HS024600/HS/AHRQ HHS/United States
GR  - K24 HL083113/HL/NHLBI NIH HHS/United States
GR  - K24 DK101828/DK/NIDDK NIH HHS/United States
GR  - K01 DK101677/DK/NIDDK NIH HHS/United States
GR  - F30 DK095545/DK/NIDDK NIH HHS/United States
GR  - K01 DK114388/DK/NIDDK NIH HHS/United States
GR  - R01 DK104876/DK/NIDDK NIH HHS/United States
GR  - R03 AI126090/AI/NIAID NIH HHS/United States
GR  - K23 DK097184/DK/NIDDK NIH HHS/United States
GR  - R01 DK098759/DK/NIDDK NIH HHS/United States
PT  - Journal Article
PT  - Research Support, N.I.H., Extramural
PL  - United States
TA  - JAMA
JT  - JAMA
JID - 7501160
SB  - AIM
SB  - IM
CIN - JAMA. 2018 Jan 2;319(1):24-26. PMID: 29297060
MH  - Adult
MH  - African Americans
MH  - Asian Americans
MH  - Cohort Studies
MH  - European Continental Ancestry Group
MH  - Female
MH  - Healthcare Disparities/*ethnology/trends
MH  - Hispanic Americans
MH  - Humans
MH  - Kaplan-Meier Estimate
MH  - Kidney Failure, Chronic/*ethnology/surgery
MH  - Kidney Transplantation/mortality/*trends
MH  - *Living Donors
MH  - Male
MH  - Middle Aged
MH  - United States/epidemiology
MH  - Waiting Lists
EDAT- 2018/01/04 06:00
MHDA- 2018/01/11 06:00
CRDT- 2018/01/04 06:00
PHST- 2018/01/04 06:00 [entrez]
PHST- 2018/01/04 06:00 [pubmed]
PHST- 2018/01/11 06:00 [medline]
AID - 2667722 [pii]
AID - 10.1001/jama.2017.19152 [doi]
PST - ppublish
SO  - JAMA. 2018 Jan 2;319(1):49-61. doi: 10.1001/jama.2017.19152.