Introduction: American Indian (AI) patients experience delays in every step of the kidney transplant (KTx) evaluation. Our objective is to determine the contribution of co-morbid and psychosocial factors to explain the delays in the KTx process. Methods: We analyzed 300 AI patients and 300 non-Hispanic white patients matched for evaluation year from 2012-2016 at a single transplant center. Results: AI patients were younger, had higher BMI, higher rates of diabetes and in-center dialysis compared to whites (p<0.01). They had lower income, less education, and lived further away from TX center compared to whites (p<0.001). Delay in the time from date of referral to KTx evaluation was association with AI race (35.1 days,p=0.003), distance from TX center (29.0 days,p=0.012), history of coronary artery disease (CAD) (31.9 days,p=0.024) , and time on dialysis (3.8 days per dialysis year,p=0.044) on multivariate analysis. Annual rate of waitlisting was 53.9% for 1^st year vs 74% and 58.8% for 2^nd year vs 74% for AI patients compared to whites, p<0.0001. On univariate analysis, predictors of decreased likelihood of progressing from evaluation to UNOS listing included older age, longer time on dialysis, diabetes, heart failure, CAD and peripheral vascular disease (PVD) (all p<0.01). Of the socio-economic factors, AI race, absence of a caregiver, non-private insurance, <high school education, below poverty income level, history of illegal drug use and functional limitation were significant predictors (all p<0.01). On multivariate analysis, older age, PVD, absence of caregiver, functional limitation, and history of illegal drug use were predictive of decreased likelihood of listing after evaluation (p<0.05). The annual incidence of kidney transplant was lower for AI patients compared to whites (p<0.0001). Predictors of KTx after listing are shown.

Discussion. AI race is independently associated with decreased likelihood of undergoing KTx evaluation and receiving KTx after listing. Further studies evaluating provider bias and patient motivation for transplant are necessary to define and help eradicate racial disparity for AI patients.

CITATION INFORMATION: Keddis M., Ilyas M., Zhang N., Khamash H., Leischow S., Sharma A., Heilman R. Determinants of Delays and Reduced Rates of Waitlisting and Kidney Transplant among American Indians Am J Transplant. 2017;17 (suppl 3).

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