Overview: Racial disparities in access to kidney transplantation persist along multiple transplant steps, including start of the transplant evaluation. No studies have identified barriers that may perpetuate disparities in starting evaluation.

Methods: We administered a phone survey to adult ESRD patients referred for transplant to 3 Georgia centers in 2016. Patients completed a researcher-developed Barriers to Transplantation Scale measuring 17 perceived barriers to starting evaluation, with each item on a 5-point Likert scale (Cronbach α=0.8). We compared agreement (agree/strongly agree) versus no agreement (all other responses) to items by race (Black vs white) via chi-square or Fisher's exact tests.

Results: Our preliminary study population consists of 379 patients, of whom 49% did not attend evaluation. Blacks (n=285) were less likely to attend (48%) compared to whites (60%) (p=0.046). Black vs whites were also younger (median age: 54 ± 19 years) (p<0.01), 57% male (p=0.07), less likely to complete high school (87%) (p<0.01), and had public insurance (87%) (p<0.01). Pre-evaluation barriers reported include concerns about transplant wait time (56%), affording post-transplant medication (36%), and finding a donor (33%). Overall, Blacks were more likely to report “I thought I was already waitlisted” (p=0.02), “My health insurance would not cover the cost of transplant” (p=0.02), “I didn't have transportation to get to the transplant center” (p=0.01), “I didn't think anyone would be able to take care of me after my transplant” (p<0.01), and “I did not understand the benefits of transplantation” (p=0.02) compared to whites. Among attendees, Blacks were more likely to state “I didn't have transportation to get to the transplant center"(p=0.01); among absentees, Blacks were more likely to state “I didn't think anyone would be able to take care of me after my transplant” (p=0.02).

Conclusion: Black patients experienced significant barriers to starting the evaluation compared to whites. Development of culturally sensitive interventions targeting barriers to starting evaluation is needed to reduce racial disparities in access to kidney transplant.

CITATION INFORMATION: Hamoda R., McPherson L., Lipford K., Gander J., Pastan S., Patzer R. Racial Differences in Patient-Perceived Barriers to Starting the Kidney Transplant Evaluation Am J Transplant. 2017;17 (suppl 3).

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