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Barriers to Listing for Kidney Transplantation in LMICs: A Single Center Retrospective Cohort Study in Brazil

Y. Yu1, G. Ferreira2, A. Saha1, M. Henderson1, D. Segev1, J. Bastos2, V. Colares2, A. Massie1

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

Related Abstracts
  • Racial and Income-Based Disparities in Access to Kidney Transplantation in the Context of a Nationally-Financed Health System in Brazil
  • Ethnocultural Barriers to Pre-Emptive Kidney Transplantation: A Single Centre Retrospective Cohort Study.

*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.

Table1: Adjusted hazard ratio of demographic factors associated with listing
aHRP>z
Race
WhiteRef
Black0.89 1.05 1.240.59
Pardo1.19 1.41 1.67P<0.001
Age at evaluation per 10 years0.80 0.85 0.89P<0.001
Female0.93 1.07 1.230.36
Table2: Adjusted Hazard ratio of risk factors associated with listing
aHRP>z
Diabetes0.46 0.60 0.79P<0.001
Income
<1400Ref
1400-20000.82 1.10 1.470.53
2000-30000.86 1.30 1.760.09
>30001.20 2.24 1.640.002
*This model adjusted for age, race, gender, blood type, retransplant, BMI and employment.

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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.

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