Purpose: The waiting time for a deceased donor kidney transplant (DDKT) varies greatly across the United States (US), having a significant impact on outcomes pre- and post-transplantation. The extent of the current problem and the drivers leading to areas with long waiting times has not been explored. We analyzed the waiting time differences across the 58 US Donor Service Areas (DSA) and the DSA characteristics that affect long DSA waiting times.
Methods: A retrospective analysis of the United States Renal Data System and Organ Procurement and Transplant Network databases was performed for adult end-stage renal disease patients by DSA during 2000-2009. Median waiting times were determined by DSA. Multivariate analysis was performed to identify significant DSA characteristics of long waiting times.
Results: In 2009, the median waiting times were 2.4 and 2.1 years for Standard Criteria Donors and Extended Criteria Donors, ranging from 0.6 to 5.2 years and 0.4 to 4.7 years across the 58 DSAs, respectively. This disparity in waiting times has increased from 3.3 years to 4.7 years from 2000 to 2009. Drivers of long DSA waiting times were: a high prevalence of listed transplant candidates, low local kidney donation rates, high ethnic diversity, low patient educational attainment, high public insurance dependence, and high rate of listing within the DSA of residence. DSA kidney quality and transplant center availability were not predictors of long DSA waiting times.
Conclusions: The current geographic inequity in kidney transplantation waiting time is significant, and has worsened over time. High demand for kidney transplantation, low local kidney availability, low patient socioeconomic status, and local listing behavior drive long DSA waiting times. Center behaviors, such as the use of marginal quality organs and higher rates of living donor kidney transplant, have not eliminated the geographic inequity. Changes to the allocation system are needed to mitigate this geographic inequity.
To cite this abstract in AMA style:Davis A, Mehrotra S, Friedewald J, Skaro A, McElroy L, Kang R, Holl J, Abecassis M, Ladner D. Extent and Drivers of Geographic Inequity in Kidney Transplantation in the United States, The [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/extent-and-drivers-of-geographic-inequity-in-kidney-transplantation-in-the-united-states-the/. Accessed March 31, 2020.
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