TY - JOUR
T1 - Effect of eliminating priority points for HLA-B matching on racial disparities in kidney transplant rates
AU - Hall, Erin C.
AU - Massie, Allan B.
AU - James, Nathan T.
AU - Wang, Jacqueline M.Garonzik
AU - Montgomery, Robert Avery
AU - Berger, Jonathan C.
AU - Segev, Dorry L.
N1 - Funding Information:
Support: This work was supported in part by Health Resources and Services Administration contract 234-2005-37011C. The content is the responsibility of the authors alone and does not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the US Government.
PY - 2011/11
Y1 - 2011/11
N2 - Background: African Americans have lower rates of obtaining a deceased donor kidney transplant (DDKT) compared with their white counterparts. One proposed mechanism is differential HLA distributions between African Americans and whites. In May 2003, the United Network for Organ Sharing/Organ Procurement and Transplantation Network changed kidney allocation policy to eliminate priority based on HLA-B matching in an effort to address this disparity. The objective of this study was to quantify the effect of the change in policy regarding priority points for HLA-B matching. Study Design: Observational cohort study. Setting & Participants: A cohort of 178,902 patients registered for a DDKT between January 2000 and August 2009. Factors: African Americans versus whites before and after the policy change. Cox models were adjusted for age, sex, diabetes, dialysis type, insurance status, education, panel-reactive antibody level, and blood type. Outcomes: Adjusted relative rates (aRRs) of deceased donor kidney transplant for African Americans compared with whites. Measurements: Time from initial active wait listing to DDKT, censored for living donor kidney transplant and death. Results: Before the policy change, African Americans had 37% lower rates of DDKT (aRR, 0.63; 95% CI, 0.60-0.65; P < 0.001). After the policy change, African Americans had 23% lower rates of DDKT (aRR, 0.77; 95% CI, 0.76-0.79; P < 0.001). There was a 23% reduction in the disparity between African Americans and whites after the policy change (interaction aRR, 1.23; 95% CI, 1.18-1.29; P < 0.001). Limitations: As an observational study, findings could have been affected by residual confounding or other changes in practice patterns. Conclusions: Racial disparity in rates of DDKT was decreased by the HLA-B policy change, but parity was not achieved. There are unaddressed factors in kidney allocation that lead to continued disparity on the kidney transplant waiting list.
AB - Background: African Americans have lower rates of obtaining a deceased donor kidney transplant (DDKT) compared with their white counterparts. One proposed mechanism is differential HLA distributions between African Americans and whites. In May 2003, the United Network for Organ Sharing/Organ Procurement and Transplantation Network changed kidney allocation policy to eliminate priority based on HLA-B matching in an effort to address this disparity. The objective of this study was to quantify the effect of the change in policy regarding priority points for HLA-B matching. Study Design: Observational cohort study. Setting & Participants: A cohort of 178,902 patients registered for a DDKT between January 2000 and August 2009. Factors: African Americans versus whites before and after the policy change. Cox models were adjusted for age, sex, diabetes, dialysis type, insurance status, education, panel-reactive antibody level, and blood type. Outcomes: Adjusted relative rates (aRRs) of deceased donor kidney transplant for African Americans compared with whites. Measurements: Time from initial active wait listing to DDKT, censored for living donor kidney transplant and death. Results: Before the policy change, African Americans had 37% lower rates of DDKT (aRR, 0.63; 95% CI, 0.60-0.65; P < 0.001). After the policy change, African Americans had 23% lower rates of DDKT (aRR, 0.77; 95% CI, 0.76-0.79; P < 0.001). There was a 23% reduction in the disparity between African Americans and whites after the policy change (interaction aRR, 1.23; 95% CI, 1.18-1.29; P < 0.001). Limitations: As an observational study, findings could have been affected by residual confounding or other changes in practice patterns. Conclusions: Racial disparity in rates of DDKT was decreased by the HLA-B policy change, but parity was not achieved. There are unaddressed factors in kidney allocation that lead to continued disparity on the kidney transplant waiting list.
KW - Racial disparities
KW - policy change
KW - rates of deceased donor kidney transplantation
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U2 - 10.1053/j.ajkd.2011.05.023
DO - 10.1053/j.ajkd.2011.05.023
M3 - Article
C2 - 21802805
AN - SCOPUS:80054981260
SN - 0272-6386
VL - 58
SP - 813
EP - 816
JO - American Journal of Kidney Diseases
JF - American Journal of Kidney Diseases
IS - 5
ER -