INTRODUCTION: For patients with chronic kidney disease (CKD), access to kidney transplantation (ATT) varies across the 58 Donor Service Areas (DSAs) of the United States, with wait list patients in high competition DSAs being less likely to be transplanted. We hypothesized that CKD patients in DSAs with greater competition may have greater access to the waitlist (AWL), increasing the denominator on the waitlist which may artificially drive down ATT rates, even though in reality CKD patients may have increased ATT.

METHODS: The United States Renal Data System was queried for adult incident dialysis registrations in 2008 for patient demographics, being under the care of a nephrologist, and being informed of the possibility of transplantation. To measure market competition, the Herfindahl-Hirschman Index was calculated for each DSA. AWL was defined as being listed for a deceased donor kidney or receiving a living donor kidney.

RESULTS: 104,789 adults began dialysis in 2008. Patients in high competition DSAs were 23% more likely to be informed of transplantation at the time of dialysis initiation than single center DSAs (P<0.001), but less likely to have a nephrologist before initiation of dialysis (OR 0.83, P<0.001). Subsequently, CKD patients in high competition DSAs were 57% more likely to be either listed for a deceased donor kidney or receive a living donor kidney transplant (P<0.001). CKD patients in high competition DSAs were more likely to receive a kidney transplant (OR 1.43, P<0.001).

CONCLUSIONS: Patients in more competitive DSAs are more likely to be informed of kidney transplantation as an option, and to go on and receive a kidney. This may be due to better outreach and increased awareness of kidney transplantation in more competitive DSAs.

CITATION INFORMATION: Adler J., Chang D., Yeh H. Greater Access to Kidney Transplantation in Competitive DSAs: Due to Improved Referral? Am J Transplant. 2017;17 (suppl 3).

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