Persistent regional and racial disparities in nondirected living kidney donation

Komal Kumar, Courtenay M. Holscher, Xun Luo, Jacqueline Garonzik, Saad Anjum, Elizabeth King, Allan B Massie, James A Tonascia, Tanjala Purnell, Dorry Segev

Research output: Contribution to journalArticle

Abstract

Nondirected living donors (NDLDs) are an important and growing source of kidneys to help reduce the organ shortage. In its infancy, NDLD transplantation was clustered at a few transplant centers and rarely benefited African American (AA) recipients. However, NDLDs have increased 9.4-fold since 2000, and now are often used to initiate kidney paired donation chains. Therefore, we hypothesized that the initial geographic clustering and racial disparities may have improved. We used Scientific Registry of Transplant Recipients data to compare NDLDs and their recipients between 2008-2015 and 2000-2007. We found that NDLD increased an average of 12% per year, from 20 in 2000 to 188 in 2015 (IRR: 1.12, 95% CI: 1.11-1.13, P < .001). In 2000-2007, 18.3% of recipients of NDLD kidneys were AA; this decreased in 2008-2015 to 15.7%. NDLD transplants initially became more evenly distributed across centers (Gini 0.91 in 2000 to Gini 0.69 in 2011), but then became more clustered at fewer transplant centers (Gini 0.75 in 2015). Despite the increased number of NDLDs, racial disparities have worsened and the center-level distribution of NDLD transplants has narrowed in recent years.

Original languageEnglish (US)
JournalClinical Transplantation
DOIs
StateAccepted/In press - 2017

Fingerprint

Living Donors
Kidney
Transplants
African Americans
Cluster Analysis
Registries
Transplantation

Keywords

  • Kidney allocation
  • Living donation
  • Living donor transplantation
  • Nondirected donors

ASJC Scopus subject areas

  • Transplantation

Cite this

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title = "Persistent regional and racial disparities in nondirected living kidney donation",
abstract = "Nondirected living donors (NDLDs) are an important and growing source of kidneys to help reduce the organ shortage. In its infancy, NDLD transplantation was clustered at a few transplant centers and rarely benefited African American (AA) recipients. However, NDLDs have increased 9.4-fold since 2000, and now are often used to initiate kidney paired donation chains. Therefore, we hypothesized that the initial geographic clustering and racial disparities may have improved. We used Scientific Registry of Transplant Recipients data to compare NDLDs and their recipients between 2008-2015 and 2000-2007. We found that NDLD increased an average of 12{\%} per year, from 20 in 2000 to 188 in 2015 (IRR: 1.12, 95{\%} CI: 1.11-1.13, P < .001). In 2000-2007, 18.3{\%} of recipients of NDLD kidneys were AA; this decreased in 2008-2015 to 15.7{\%}. NDLD transplants initially became more evenly distributed across centers (Gini 0.91 in 2000 to Gini 0.69 in 2011), but then became more clustered at fewer transplant centers (Gini 0.75 in 2015). Despite the increased number of NDLDs, racial disparities have worsened and the center-level distribution of NDLD transplants has narrowed in recent years.",
keywords = "Kidney allocation, Living donation, Living donor transplantation, Nondirected donors",
author = "Komal Kumar and Holscher, {Courtenay M.} and Xun Luo and Jacqueline Garonzik and Saad Anjum and Elizabeth King and Massie, {Allan B} and Tonascia, {James A} and Tanjala Purnell and Dorry Segev",
year = "2017",
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language = "English (US)",
journal = "Clinical Transplantation",
issn = "0902-0063",
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T1 - Persistent regional and racial disparities in nondirected living kidney donation

AU - Kumar, Komal

AU - Holscher, Courtenay M.

AU - Luo, Xun

AU - Garonzik, Jacqueline

AU - Anjum, Saad

AU - King, Elizabeth

AU - Massie, Allan B

AU - Tonascia, James A

AU - Purnell, Tanjala

AU - Segev, Dorry

PY - 2017

Y1 - 2017

N2 - Nondirected living donors (NDLDs) are an important and growing source of kidneys to help reduce the organ shortage. In its infancy, NDLD transplantation was clustered at a few transplant centers and rarely benefited African American (AA) recipients. However, NDLDs have increased 9.4-fold since 2000, and now are often used to initiate kidney paired donation chains. Therefore, we hypothesized that the initial geographic clustering and racial disparities may have improved. We used Scientific Registry of Transplant Recipients data to compare NDLDs and their recipients between 2008-2015 and 2000-2007. We found that NDLD increased an average of 12% per year, from 20 in 2000 to 188 in 2015 (IRR: 1.12, 95% CI: 1.11-1.13, P < .001). In 2000-2007, 18.3% of recipients of NDLD kidneys were AA; this decreased in 2008-2015 to 15.7%. NDLD transplants initially became more evenly distributed across centers (Gini 0.91 in 2000 to Gini 0.69 in 2011), but then became more clustered at fewer transplant centers (Gini 0.75 in 2015). Despite the increased number of NDLDs, racial disparities have worsened and the center-level distribution of NDLD transplants has narrowed in recent years.

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KW - Kidney allocation

KW - Living donation

KW - Living donor transplantation

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