African-American (AA) end-stage kidney disease (ESKD) patients experience several disparities in kidney transplantation (KT), including an increased time to complete transplant evaluation, as compared to Whites (WH). Differences in medical factors alone do not explain all of the disparities found. For example, prior studies have indicated that deficiencies in patients' transplant-related knowledge were associated with a decreased likelihood of receiving a living donor allograft. However, other investigations into non-medical factors (i.e., cultural, psychosocial and demographic) which contribute to disparities have been limited by their small sample sizes. Furthermore, the majority of studies have been retrospective or cross-sectional, thereby making identification of factors which are predictive of delays in kidney transplant impossible. Thus, our group has been prospectively following a large cohort of patients as they proceed through the KT evaluation process. Preliminary results from this ongoing longitudinal study are presented herein.

ESKD patients (White=772; Black 257) completed structured interviews at the time of initial transplant evaluation and when transplant evaluation was completed. AA patients were younger (p<0.001), less educated (p<0.05), less likely to be married (p<0.001), poorer (p<0.001), and less likely to be privately insured (p<0.001) than WH. Although AA reported more physical symptoms (p<0.05) and secondary effects (p<0.01) of kidney disease, there was no significant difference in the self-reported burden of kidney disease (p=0.622). AA had lower KT knowledge (p<0.001), engaged in fewer learning activities about KT (p<0.01), and for less time (p<0.01) than WH. AA took longer (M = 296.3 days, SD = 224.8 days) to complete transplant evaluation than WH (M = 212.9, SD = 177.4 days) (HR = 1.53; p<0.001). After controlling for race, patients with fewer learning activities (p=0.019) and less transplant knowledge (p=0.003) took longer to complete transplant evaluation. Many non-medical factors which result in disparities in health outcomes may be difficult to address within the context of medical care. However, deficiencies in knowledge and educational opportunities about KT may be correctable. Identifying modifiable factors will allow us to create evidence-based interventions to reduce KT disparities in the future.

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