Disparities in the Utilization of Live Donor Renal Transplantation

Published in: American Journal of Transplantation, v. 9, no. 5, May 2009, p. 1124-1133

Posted on RAND.org on December 31, 2008

by John L. Gore, G. M Danovitch, Mark Litwin, P-T T Pham, Jennifer S Singer

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Despite universal payer coverage with Medicare, sociodemographic disparities confound the care of patients with renal failure. The authors sought to determine whether adults who realize access to kidney transplantation suffer inequities in the utilization of live donor renal transplantation (LDRT). They identified adults undergoing primary renal transplantation in 2004-2006 from the United Network for Organ Sharing (UNOS). The authors modeled receipt of live versus deceased donor renal transplant on multilevel multivariate models that examined recipient, center and UNOS region-specific covariates. Among 41 090 adult recipients identified, 39% underwent LDRT. On multivariate analysis, older recipients (OR 0.62, 95% CI 0.56-0.68 for 50-59 year-olds vs.18-39 year-old recipients), those of African American ethnicity (OR 0.54, 95% CI 0.50-0.59 vs. whites) and of lower socioeconomic status (OR 0.72, 95% CI 0.67-0.79 for high school-educated vs. college-educated recipients; OR 0.78, 95% CI 0.71-0.87 for lowest vs. highest income quartile) had lower odds of LDRT. These characteristics accounted for 14.2% of the variation in LDRT, more than recipient clinical variables, transplant center characteristics and UNOS region level variation. The authors identified significant racial and socioeconomic disparities in the utilization of LDRT. Educational initiatives and dissemination of processes that enable increased utilization of LDRT may address these disparities.

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