TY - JOUR
T1 - Listing at non-local transplant centers is associated with increased access to deceased donor kidney transplantation
AU - Ross-Driscoll, Katherine
AU - Gunasti, Jonathan
AU - Lynch, Raymond J.
AU - Massie, Allan
AU - Segev, Dorry L.
AU - Snyder, Jon
AU - Axelrod, David
AU - Patzer, Rachel E.
N1 - Funding Information:
We thank CONICET and Universidad Nacional de Mar del Plata for their financial support through grants PIP 0046 and 15/E870EXA912/18, respectively.
Funding Information:
The data reported here have been supplied by the Hennepin Healthcare Research Institute (HHRI) as the contractor for the Scientific Registry of Transplant Recipients (SRTR). The interpretation and reporting of these data are the responsibility of the author(s) and in no way should be seen as an official policy of or interpretation by the SRTR or the US Government. Dr. Ross-Driscoll is supported by the National Center for Advancing Translational Sciences of the National Institutes of Health under Award Number UL1TR002378 and KL2TR002381. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Publisher Copyright:
© 2022 The American Society of Transplantation and the American Society of Transplant Surgeons.
PY - 2022/7
Y1 - 2022/7
N2 - The ability of kidney transplant candidates to travel outside of their usual place of care varies by sociodemographic factors, potentially exacerbating disparities in access. We used Transplant Referral Regions (TRRs) to overcome previous methodological barriers of using geographic distance to assess the characteristics and outcomes of patients listed for kidney transplant at centers in neighboring TRR or beyond neighboring TRRs. Among listed kidney transplant candidates, 20.9% traveled to a neighbor and 5.6% beyond a neighbor. A higher proportion of travelers were White, had some college education, and lived in ZIP codes with lower poverty. Travel to a neighbor was associated with a 7% increase in likelihood of deceased donor transplant (cHR: 1.07, 95% CI: 1.05, 1.09) and traveling beyond a neighbor with a 19% increase (cHR: 1.19, 95% CI: 1.15, 1.24). Travelers had similar rates of living donor transplant and waitlist mortality as patients who did not travel; those who traveled beyond a neighbor had slightly lower posttransplant mortality (HR: 0.91, 95% CI: 0.83, 0.99). In conclusion, the ability to travel outside of the recipient's assigned TRR increases access to transplantation and improves long-term survival. (Figure presented.).
AB - The ability of kidney transplant candidates to travel outside of their usual place of care varies by sociodemographic factors, potentially exacerbating disparities in access. We used Transplant Referral Regions (TRRs) to overcome previous methodological barriers of using geographic distance to assess the characteristics and outcomes of patients listed for kidney transplant at centers in neighboring TRR or beyond neighboring TRRs. Among listed kidney transplant candidates, 20.9% traveled to a neighbor and 5.6% beyond a neighbor. A higher proportion of travelers were White, had some college education, and lived in ZIP codes with lower poverty. Travel to a neighbor was associated with a 7% increase in likelihood of deceased donor transplant (cHR: 1.07, 95% CI: 1.05, 1.09) and traveling beyond a neighbor with a 19% increase (cHR: 1.19, 95% CI: 1.15, 1.24). Travelers had similar rates of living donor transplant and waitlist mortality as patients who did not travel; those who traveled beyond a neighbor had slightly lower posttransplant mortality (HR: 0.91, 95% CI: 0.83, 0.99). In conclusion, the ability to travel outside of the recipient's assigned TRR increases access to transplantation and improves long-term survival. (Figure presented.).
KW - disparities
KW - health services and outcomes research
KW - kidney transplantation/nephrology
KW - patient characteristics
KW - registry/registry analysis
KW - Scientific Registry for Transplant Recipients (SRTR)
UR - http://www.scopus.com/inward/record.url?scp=85127611219&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85127611219&partnerID=8YFLogxK
U2 - 10.1111/ajt.17044
DO - 10.1111/ajt.17044
M3 - Article
C2 - 35338697
AN - SCOPUS:85127611219
VL - 22
SP - 1813
EP - 1822
JO - American Journal of Transplantation
JF - American Journal of Transplantation
SN - 1600-6135
IS - 7
ER -