Kidney transplant rules may curb disparities

Kidney transplant is the preferred treatment for patients with end stage renal disease because it helps them live longer with a better quality of life and fewer hospitalizations than dialysis, the alternative. The primary factor the United Network for Organ Sharing (UNOS) uses for allocating kidneys from deceased donors is how long patients have been waiting for organs.

Under the old UNOS system, waiting times were largely based on when people joined the waiting list for a kidney. In part to address long-standing racial and ethnic disparities in the old system, in 2014 UNOS started calculating wait times based either on when people joined the waiting list or when they began dialysis, whichever came first.

For the study, researchers examined data on 179,071 people on the kidney transplant waiting list from June 2013 to September 2016, including the 34,133 individuals who received organs.

White patients had a significantly higher kidney transplant rate than black or Hispanic patients under the old system, but with the new system the differences narrowed to the point where they might have been due to chance.

For some patients, it can take months or even years to get on the waiting list, due to significant delays and differences in how long doctors might wait to send patients for evaluation at transplant centers, said senior study author Dr. Rachel Patzer of Emory University School of Medicine in Atlanta.

“The new system tends to even the playing field by starting the clock at the start of the disease process,” Patzer told Reuters Health.

“For those that get a transplant sooner, their post-transplant survival is much better the less time spent on dialysis prior to transplant,” Patzer said by email.

The monthly transplant rate under the old UNOS system was 1.07 percent for white patients, compared with 0.80 percent for black people and 0.79 for Hispanics.

With the new system, however, the monthly transplant rate dropped to 0.95 percent for white people. At the same time, it rose to 0.96 percent for black people and 0.91 percent for Hispanic patients, researchers report in Health Affairs.

One limitation of the study is the relatively short duration of follow-up time after the new UNOS system took effect, the authors note. They also lacked data that might show how individual patient characteristics influenced who received a kidney or how long they waited.

Under the old system, for example, white patients might have had an advantage because they were more likely to have private health insurance, access to education about transplants or a car to get to the transplant center, said Amy Waterman, deputy director, Transplant Research and Education Center at the Terasaki Research Institute affiliated with the University of California Los Angeles.

“Since the clock started for waiting time when patients were listed at the transplant center officially, those who went forward for transplant evaluation faster, the white patients, benefited since they could begin accruing waiting time and move up the waiting list for a matching kidney,” Waterman, who wasn’t involved in the study, said by email.

The longer patients remain on dialysis, the more likely they are to die or develop other illnesses or complications of end stage renal disease that decrease their ability to have a transplant, said Dr. Clive Callender, a researcher at Howard University College of Medicine and founder and president of the National Minority Organ Tissue Transplant Education Program (MOTTEP) who wasn’t involved in the study.

“The best advice is to get transplanted without dialysis and with a live donor,” Callender said by email.

“The fewer dialysis treatments you have, the better the chances you survive for a long period of time,” Callender said.

SOURCE: bit.ly/2qKFVDY Health Affairs, online June 5, 2017.