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Geographic Variation in Listing for Kidney Transplantation: A State-Level Assessment of Access among Patients with End-Stage Renal Disease in the United States

M. N. Mustian, H. Qu, D. Anderson, P. A. MacLennan, R. D. Reed, C. Kale, B. Orandi, B. A. Shelton, V. Kumar, M. Hanaway, J. E. Locke

University of Alabama at Birmingham, Birmingham, AL

Meeting: 2020 American Transplant Congress

Abstract number: B-018

Keywords: Kidney transplantation, Renal failure, Waiting lists

Session Information

Date: Saturday, May 30, 2020

Session Name: Poster Session B: Kidney Deceased Donor Allocation

Session Time: 3:15pm-4:00pm

 Presentation Time: 3:30pm-4:00pm

Location: Virtual

Related Abstracts
  • Higher State-Level Demand for Renal Transplantation is Associated with Lower Deceased Donor Kidney Transplantation Rate
  • Racial/Ethnic Differences in the Association Between Hospitalization and Kidney Transplantation Among Waitlisted End Stage Renal Disease (ESRD) Patients: A Multi-Level Mixed Modeling Approach

*Purpose: Barriers to deceased donor kidney transplantation (DDKT) exist, including referral for transplant and waitlist addition, which may vary regionally. The objective of this study was to assess the state-level period prevalence of end-stage renal disease (ESRD) patients eligible for DDKT and to measure access to the waitlist among this population.

*Methods: Methods: The 2016 United States Renal Data System database was used to estimate the 2014 period prevalence of adult (18-74 years) ESRD patients eligible for DDKT in 2014, per our transplant center’s standardized criteria (1/1/2014-12/31/2014). Based on UNOS data, the proportion of waitlisted candidates per eligible ESRD patients was calculated. Spearman’s correlation was used to evaluate the association between ESRD burden and proportion of transplant-eligible patients who were waitlisted, by state.

*Results: Among 450,828 ESRD patients identified, 364,358 were eligible for transplant per criteria. ESRD eligible patients varied geographically, and there was significant variation in the proportion of transplant-eligible ESRD patients who were waitlisted, with a mean of 24.84 per 100 eligible patients (Figure 1). A negative correlation existed between state-level ESRD burden and proportion of eligible patients who were waitlisted (r =-0.39, p=0.01).

*Conclusions: Geographic variation existed for waitlisting practices among transplant-eligible ESRD patients, and higher burden of ESRD was not associated with higher proportion of waitlisted transplant-eligible patients. Therefore, waitlist size may be more of a reflection of center/state-level practices than true disease burden. Moreover, on a national and state level, opportunity exists to provide greater access to the waitlist among patients with ESRD.

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To cite this abstract in AMA style:

Mustian MN, Qu H, Anderson D, MacLennan PA, Reed RD, Kale C, Orandi B, Shelton BA, Kumar V, Hanaway M, Locke JE. Geographic Variation in Listing for Kidney Transplantation: A State-Level Assessment of Access among Patients with End-Stage Renal Disease in the United States [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/geographic-variation-in-listing-for-kidney-transplantation-a-state-level-assessment-of-access-among-patients-with-end-stage-renal-disease-in-the-united-states/. Accessed March 3, 2021.

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