Disparities research has traditionally focused on patient-level variables to ascertain predominant risk factors driving differences in outcomes for African-American (AA) kidney transplant (KTX) recipients. The objective of this analysis was to determine the magnitude and impact of transplant center variability for graft outcome disparities.

Methods: Analysis of U.S. UNOS registry data, focusing on KTX recipients transplanted from 1990 to 2014. Pediatrics, non-AAs, non-Caucasians, non-renal transplants and centers transplanting <50 AAs were excluded. Multivariable Cox and linear regression were utilized to assess adjusted risk in AAs by center and determine which center-level factors were associated with risk.

Results: 257,024 KTXs from 186 centers were included; AAs represented 31.1% of KTXs. After adjusting for baseline characteristics, AAs had 45% higher risk of graft loss (aHR 1.45, 1.42-1.48, p<0.001). Center variability for graft outcome disparities in AAs was high, with the aHRs ranging from 0.56 to 4.0 (Figure 1: caterpillar plot of aHRs by center); 38% of centers demonstrated a non-statistically significant disparity (HR 95% CI crossed 1.00) and 21% of centers had a large AA disparity (aHR >1.75). Center-level factors significantly associated with increasing disparity included differences in acute rejection rates and initial hospital length of stay (LOS) between AAs and Caucasians (Table 1); a 10% increase in acute rejection difference led to an estimated increase in graft loss disparity of 19%. A one day difference in LOS led to an estimated increase in graft loss disparity of 21%. Transplant center volume, living donor rates and insurance differences had no appreciable influence on center-level disparities.

Conclusion: After controlling for patient-level factors, there appears to be wide variation in center-level disparities for graft outcomes in AA KTX recipients. More research is needed to understand the transplant center systems and processes that may help explain these differences in outcomes for AA KTX recipients.

CITATION INFORMATION: Taber D, Gebregziabher M, Egede L, Baliga P. Transplant Center Variability in Disparities for African-American Kidney Transplant Recipients. Am J Transplant. 2017;17 (suppl 3).

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