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

Session Name: Poster Session D: Non-Organ Specific: Economics & Ethics

Session Type: Poster Session

Date: Tuesday, June 4, 2019

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.

Table1: Adjusted hazard ratio of demographic factors associated with listing
	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	_0.931.07 _1.23	0.36

Table2: Adjusted Hazard ratio of risk factors associated with listing
	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 July 14, 2025.

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