Barriers to Listing for Kidney Transplantation in LMICs: A Single Center Retrospective Cohort Study in Brazil
1Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD, 2Santa Casa de Misericordia de Juiz de Fora, Juiz de Fora, Brazil
Meeting: 2019 American Transplant Congress
Abstract number: D195
Keywords: Economics, Ethics, Kidney transplantation
Session Information
Date: Tuesday, June 4, 2019
Session Name: Poster Session D: Non-Organ Specific: Economics & Ethics
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Hall C & D
*Purpose: Incidence of end-stage renal disease (ESRD) is increasing in low- and middle-income countries (LMICs), but citizens of LMICs face barriers to transplantation that are poorly understood. We seek to characterize barriers to kidney transplantation (KT) listing in Brazil, which has a nationally-financed transplantation system and has the second highest volume of KT worldwide.
*Methods: We analyzed time from evaluation to listing among 1638 ESRD patients 2012-2018 at a large transplant center in Brazil. Using multivariable Cox regression, we explored the risk factors associated with listing for KT, including age, sex, race (White/Asian, Black, or pardo (mixed-race)), blood type, transplant number, diabetes status, and income quartile (Q1 (lowest)-Q4(highest)).
*Results: We analyzed time from evaluation to listing among 1638 ESRD patients 2012-2018 at a large transplant center in Brazil. Using multivariable Cox regression, we explored the risk factors associated with listing for KT, including age, sex, race (White/Asian, Black, or pardo (mixed-race)), blood type, transplant number, diabetes status, and income quartile (Q1 (lowest)-Q4(highest)).
*Conclusions: Despite Brazil’s publicly financed healthcare system and priority points for diabetic KT candidates in Brazilian kidney allocation, lower household income, older age, and having diabetes substantially lower a patient’s chance of transplant.
| aHR | P>z | |
| Race | ||
| White | Ref | |
| Black | 0.89 1.05 1.24 | 0.59 |
| Pardo | 1.19 1.41 1.67 | P<0.001 |
| Age at evaluation per 10 years | 0.80 0.85 0.89 | P<0.001 |
| Female | 0.93 1.07 1.23 | 0.36 |
| aHR | P>z | |
| Diabetes | 0.46 0.60 0.79 | P<0.001 |
| Income | ||
| <1400 | Ref | |
| 1400-2000 | 0.82 1.10 1.47 | 0.53 |
| 2000-3000 | 0.86 1.30 1.76 | 0.09 |
| >3000 | 1.20 2.24 1.64 | 0.002 |
| *This model adjusted for age, race, gender, blood type, retransplant, BMI and employment. | ||
To cite this abstract in AMA style:
Yu Y, Ferreira G, Saha A, Henderson M, Segev D, Bastos J, Colares V, Massie A. Barriers to Listing for Kidney Transplantation in LMICs: A Single Center Retrospective Cohort Study in Brazil [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/barriers-to-listing-for-kidney-transplantation-in-lmics-a-single-center-retrospective-cohort-study-in-brazil/. Accessed December 14, 2019.« Back to 2019 American Transplant Congress