Background and objectives: Hispanic Americans face disparities in access to kidney transplantation, particularly living donor kidney transplantation (LDKT).

Design, setting, participants, and measurements: Northwestern Medicine's® (NM) Hispanic Kidney Transplant Program (HKTP), initiated in December 2006, delivers culturally and linguistically competent and congruent care. Program-specific data were used to compare the mean ratios of Hispanic to non-Hispanic white LDKTs between pre-HKTP (2001-2006) and post-HKTP (2008-2013) and to compare the characteristics of NM's® adult LDKT patients, pre-HKTP to post-HKTP. The same ratio was calculated for transplant centers in regions with a significant Hispanic population (≥25%) and performing in the top tertile of total LDKT volume between 2001 and 2006.

Results: The ratio of Hispanic to non-Hispanic white LDKTs significantly increased by 70% after the implementation of NM's® HKTP (pre-HKTP mean=0.20, post-HKTP mean=0.34; p=0.001). No other transplant center demonstrated a significant increase in their ratio of Hispanic to Non-Hispanic white LDKTs. At NM®, the mean annual number of Hispanic LDKTs performed grew from 16.7 (pre-HKTP) to 29.0 (post-HKTP). The mean annual number of non-Hispanic white LDKTs remained stable from pre- to post-HKTP (pre=82, post=87; p=0.32). The increase in Hispanic LDKTs did not occur at the expense of non-Hispanic white LDKTs. None of the other 29 U.S. transplant centers in the comparison UNOS regions experienced significant increases in their ratio of Hispanic to non-Hispanic white LDKTs from pre- to post-HKTP periods. In sensitivity analyses, the LDKT ratio remained significant for NM® but was insignificant for all other centers when including 2007 (implementation period) with the post-HKTP period. Further, the NM® mean ratio of African American to non-Hispanic white LDKTs also did not significantly increase (pre=0.26, post=0.32, p=0.23), further suggesting that the HKTP increased Hispanic LDKTs only.

Conclusions: These data suggest that the development and implementation of a culturally congruent transplant program can positively affect Hispanic LDKT and thereby reduce Hispanics disparities in LDKT rates. Further studies are needed to prospectively evaluate the applicability and impact of culturally competent interventions.

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