Center-level factors and racial disparities in living donor kidney transplantation

Erin C. Hall, Nathan T. James, Jacqueline Garonzik, Jonathan C. Berger, Robert A. Montgomery, Nabil N. Dagher, Niraj M Desai, Dorry Segev

Research output: Contribution to journalArticle

Abstract

Background: On average, African Americans attain living donor kidney transplantation (LDKT) at decreased rates compared with their non-African American counterparts. However, center-level variations in this disparity or the role of center-level factors is unknown. Study Design: Observational cohort study. Setting & Participants: 247,707 adults registered for first-time kidney transplants from 1995-2007 as reported by the Scientific Registry of Transplant Recipients. Predictors: Patient-level factors (age, sex, body mass index, insurance status, education, blood type, and panel-reactive antibody level) were adjusted for in all models. The association of center-level characteristics (number of candidates, transplant volume, LDKT volume, median time to transplant, percentage of African American candidates, percentage of prelisted candidates, and percentage of LDKT) and degree of racial disparity in LDKT was quantified. Outcomes: Hierarchical multivariate logistic regression models were used to derive center-specific estimates of LDKT attainment in African American versus non-African American candidates. Results: Racial parity was not seen at any of the 275 transplant centers in the United States. At centers with the least racial disparity, African Americans had 35% lower odds of receiving LDKT; at centers with the most disparity, African Americans had 76% lower odds. Higher percentages of African American candidates (interaction term, 0.86; P = 0.03) and prelisted candidates (interaction term, 0.80; P = 0.001) at a given center were associated with increased racial disparity at that center. Higher rates of LDKT (interaction term, 1.25; P <0.001) were associated with less racial disparity. Limitations: Some patient-level factors are not captured, including a given patient's pool of potential donors. Geographic disparities in deceased donor availability might affect LDKT rates. Center-level policies and practices are not captured. Conclusions: Racial disparity in attainment of LDKT exists at every transplant center in the country. Centers with higher rates of LDKT attainment for all races had less disparity; these high-performing centers might provide insights into policies that might help address this disparity.

Original languageEnglish (US)
Pages (from-to)849-857
Number of pages9
JournalAmerican Journal of Kidney Diseases
Volume59
Issue number6
DOIs
StatePublished - Jun 2012

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Living Donors
Kidney Transplantation
African Americans
Transplants
Logistic Models
Tissue Donors
Sex Factors
Insurance Coverage
Age Factors
Parity
Observational Studies
Registries
Body Mass Index
Cohort Studies
Kidney
Education
Antibodies

Keywords

  • center-level effects
  • hierarchical modeling
  • Live donor kidney transplantation
  • racial disparities

ASJC Scopus subject areas

  • Nephrology

Cite this

Center-level factors and racial disparities in living donor kidney transplantation. / Hall, Erin C.; James, Nathan T.; Garonzik, Jacqueline; Berger, Jonathan C.; Montgomery, Robert A.; Dagher, Nabil N.; Desai, Niraj M; Segev, Dorry.

In: American Journal of Kidney Diseases, Vol. 59, No. 6, 06.2012, p. 849-857.

Research output: Contribution to journalArticle

Hall, Erin C. ; James, Nathan T. ; Garonzik, Jacqueline ; Berger, Jonathan C. ; Montgomery, Robert A. ; Dagher, Nabil N. ; Desai, Niraj M ; Segev, Dorry. / Center-level factors and racial disparities in living donor kidney transplantation. In: American Journal of Kidney Diseases. 2012 ; Vol. 59, No. 6. pp. 849-857.
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abstract = "Background: On average, African Americans attain living donor kidney transplantation (LDKT) at decreased rates compared with their non-African American counterparts. However, center-level variations in this disparity or the role of center-level factors is unknown. Study Design: Observational cohort study. Setting & Participants: 247,707 adults registered for first-time kidney transplants from 1995-2007 as reported by the Scientific Registry of Transplant Recipients. Predictors: Patient-level factors (age, sex, body mass index, insurance status, education, blood type, and panel-reactive antibody level) were adjusted for in all models. The association of center-level characteristics (number of candidates, transplant volume, LDKT volume, median time to transplant, percentage of African American candidates, percentage of prelisted candidates, and percentage of LDKT) and degree of racial disparity in LDKT was quantified. Outcomes: Hierarchical multivariate logistic regression models were used to derive center-specific estimates of LDKT attainment in African American versus non-African American candidates. Results: Racial parity was not seen at any of the 275 transplant centers in the United States. At centers with the least racial disparity, African Americans had 35{\%} lower odds of receiving LDKT; at centers with the most disparity, African Americans had 76{\%} lower odds. Higher percentages of African American candidates (interaction term, 0.86; P = 0.03) and prelisted candidates (interaction term, 0.80; P = 0.001) at a given center were associated with increased racial disparity at that center. Higher rates of LDKT (interaction term, 1.25; P <0.001) were associated with less racial disparity. Limitations: Some patient-level factors are not captured, including a given patient's pool of potential donors. Geographic disparities in deceased donor availability might affect LDKT rates. Center-level policies and practices are not captured. Conclusions: Racial disparity in attainment of LDKT exists at every transplant center in the country. Centers with higher rates of LDKT attainment for all races had less disparity; these high-performing centers might provide insights into policies that might help address this disparity.",
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T1 - Center-level factors and racial disparities in living donor kidney transplantation

AU - Hall, Erin C.

AU - James, Nathan T.

AU - Garonzik, Jacqueline

AU - Berger, Jonathan C.

AU - Montgomery, Robert A.

AU - Dagher, Nabil N.

AU - Desai, Niraj M

AU - Segev, Dorry

PY - 2012/6

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N2 - Background: On average, African Americans attain living donor kidney transplantation (LDKT) at decreased rates compared with their non-African American counterparts. However, center-level variations in this disparity or the role of center-level factors is unknown. Study Design: Observational cohort study. Setting & Participants: 247,707 adults registered for first-time kidney transplants from 1995-2007 as reported by the Scientific Registry of Transplant Recipients. Predictors: Patient-level factors (age, sex, body mass index, insurance status, education, blood type, and panel-reactive antibody level) were adjusted for in all models. The association of center-level characteristics (number of candidates, transplant volume, LDKT volume, median time to transplant, percentage of African American candidates, percentage of prelisted candidates, and percentage of LDKT) and degree of racial disparity in LDKT was quantified. Outcomes: Hierarchical multivariate logistic regression models were used to derive center-specific estimates of LDKT attainment in African American versus non-African American candidates. Results: Racial parity was not seen at any of the 275 transplant centers in the United States. At centers with the least racial disparity, African Americans had 35% lower odds of receiving LDKT; at centers with the most disparity, African Americans had 76% lower odds. Higher percentages of African American candidates (interaction term, 0.86; P = 0.03) and prelisted candidates (interaction term, 0.80; P = 0.001) at a given center were associated with increased racial disparity at that center. Higher rates of LDKT (interaction term, 1.25; P <0.001) were associated with less racial disparity. Limitations: Some patient-level factors are not captured, including a given patient's pool of potential donors. Geographic disparities in deceased donor availability might affect LDKT rates. Center-level policies and practices are not captured. Conclusions: Racial disparity in attainment of LDKT exists at every transplant center in the country. Centers with higher rates of LDKT attainment for all races had less disparity; these high-performing centers might provide insights into policies that might help address this disparity.

AB - Background: On average, African Americans attain living donor kidney transplantation (LDKT) at decreased rates compared with their non-African American counterparts. However, center-level variations in this disparity or the role of center-level factors is unknown. Study Design: Observational cohort study. Setting & Participants: 247,707 adults registered for first-time kidney transplants from 1995-2007 as reported by the Scientific Registry of Transplant Recipients. Predictors: Patient-level factors (age, sex, body mass index, insurance status, education, blood type, and panel-reactive antibody level) were adjusted for in all models. The association of center-level characteristics (number of candidates, transplant volume, LDKT volume, median time to transplant, percentage of African American candidates, percentage of prelisted candidates, and percentage of LDKT) and degree of racial disparity in LDKT was quantified. Outcomes: Hierarchical multivariate logistic regression models were used to derive center-specific estimates of LDKT attainment in African American versus non-African American candidates. Results: Racial parity was not seen at any of the 275 transplant centers in the United States. At centers with the least racial disparity, African Americans had 35% lower odds of receiving LDKT; at centers with the most disparity, African Americans had 76% lower odds. Higher percentages of African American candidates (interaction term, 0.86; P = 0.03) and prelisted candidates (interaction term, 0.80; P = 0.001) at a given center were associated with increased racial disparity at that center. Higher rates of LDKT (interaction term, 1.25; P <0.001) were associated with less racial disparity. Limitations: Some patient-level factors are not captured, including a given patient's pool of potential donors. Geographic disparities in deceased donor availability might affect LDKT rates. Center-level policies and practices are not captured. Conclusions: Racial disparity in attainment of LDKT exists at every transplant center in the country. Centers with higher rates of LDKT attainment for all races had less disparity; these high-performing centers might provide insights into policies that might help address this disparity.

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