OBJECTIVE: In this study, we sought to assess likelihood of living donor kidney transplantation (LDKT) within a single-center kidney transplant waitlist, by race and sex, after implementation of an incompatible program. SUMMARY BACKGROUND DATA: Disparities in access to LDKT exist among minority women and may be partially explained by antigen sensitization secondary to prior pregnancies, transplants, or blood transfusions, creating difficulty finding compatible matches. To address these and other obstacles, an incompatible LDKT program, incorporating desensitization and kidney paired donation, was created at our institution. METHODS: A retrospective cohort study was performed among our kidney transplant waitlist candidates (n = 8895). Multivariable Cox regression was utilized, comparing likelihood of LDKT before (era 1: 01/2007-01/2013) and after (era 2: 01/2013-11/2018) implementation of the incompatible program. Candidates were stratified by race [white vs minority (nonwhite)], sex, and breadth of sensitization. RESULTS: Program implementation resulted in the nation's longest single-center kidney chain, and likelihood of LDKT increased by 70% for whites [adjusted hazard ratio (aHR) 1.70; 95% confidence interval (CI), 1.46-1.99] and more than 100% for minorities (aHR 2.05; 95% CI, 1.60-2.62). Improvement in access to LDKT was greatest among sensitized minority women [calculated panel reactive antibody (cPRA) 11%-49%: aHR 4.79; 95% CI, 2.27-10.11; cPRA 50%-100%: aHR 4.09; 95% CI, 1.89-8.82]. CONCLUSIONS: Implementation of an incompatible program, and the resulting nation's longest single-center kidney chain, mitigated disparities in access to LDKT among minorities, specifically sensitized women. Extrapolation of this success on a national level may further serve these vulnerable populations.
OBJECTIVE: In this study, we sought to assess likelihood of living donor kidney transplantation (LDKT) within a single-center kidney transplant waitlist, by race and sex, after implementation of an incompatible program. SUMMARY BACKGROUND DATA: Disparities in access to LDKT exist among minority women and may be partially explained by antigen sensitization secondary to prior pregnancies, transplants, or blood transfusions, creating difficulty finding compatible matches. To address these and other obstacles, an incompatible LDKT program, incorporating desensitization and kidney paired donation, was created at our institution. METHODS: A retrospective cohort study was performed among our kidney transplant waitlist candidates (n = 8895). Multivariable Cox regression was utilized, comparing likelihood of LDKT before (era 1: 01/2007-01/2013) and after (era 2: 01/2013-11/2018) implementation of the incompatible program. Candidates were stratified by race [white vs minority (nonwhite)], sex, and breadth of sensitization. RESULTS: Program implementation resulted in the nation's longest single-center kidney chain, and likelihood of LDKT increased by 70% for whites [adjusted hazard ratio (aHR) 1.70; 95% confidence interval (CI), 1.46-1.99] and more than 100% for minorities (aHR 2.05; 95% CI, 1.60-2.62). Improvement in access to LDKT was greatest among sensitized minority women [calculated panel reactive antibody (cPRA) 11%-49%: aHR 4.79; 95% CI, 2.27-10.11; cPRA 50%-100%: aHR 4.09; 95% CI, 1.89-8.82]. CONCLUSIONS: Implementation of an incompatible program, and the resulting nation's longest single-center kidney chain, mitigated disparities in access to LDKT among minorities, specifically sensitized women. Extrapolation of this success on a national level may further serve these vulnerable populations.
Authors: Tanjala S Purnell; Xun Luo; Lisa A Cooper; Allan B Massie; Lauren M Kucirka; Macey L Henderson; Elisa J Gordon; Deidra C Crews; L Ebony Boulware; Dorry L Segev Journal: JAMA Date: 2018-01-02 Impact factor: 56.272
Authors: R A Wolfe; V B Ashby; E L Milford; A O Ojo; R E Ettenger; L Y Agodoa; P J Held; F K Port Journal: N Engl J Med Date: 1999-12-02 Impact factor: 91.245
Authors: David A Axelrod; Nino Dzebisashvili; Mark A Schnitzler; Paolo R Salvalaggio; Dorry L Segev; Sommer E Gentry; Janet Tuttle-Newhall; Krista L Lentine Journal: Clin J Am Soc Nephrol Date: 2010-08-26 Impact factor: 8.237
Authors: Giske Ursin; Leslie Bernstein; Yaping Wang; Sarah J Lord; Dennis Deapen; Jonathan M Liff; Sandra A Norman; Linda K Weiss; Janet R Daling; Polly A Marchbanks; Kathleen E Malone; Suzanne G Folger; Jill A McDonald; Ronald T Burkman; Michael S Simon; Brian L Strom; Robert Spirtas Journal: Cancer Date: 2004-07-15 Impact factor: 6.860
Authors: Elisa J Gordon; Jefferson J Uriarte; Jungwha Lee; Raymong Kang; Michelle Shumate; Richard Ruiz; Amit K Mathur; Daniela P Ladner; Juan Carlos Caicedo Journal: Am J Transplant Date: 2021-10-17 Impact factor: 8.086
Authors: Lisa M Curtis; James George; Volker Vallon; Stephen Barnes; Victor Darley-Usmar; Sucheta Vaingankar; Gary R Cutter; Orlando M Gutierrez; Michael Seifert; Joachim H Ix; Ravindra L Mehta; Paul W Sanders; Anupam Agarwal Journal: Am J Physiol Renal Physiol Date: 2021-03-29
Authors: Asuncion Sancho; Eva Gavela; Julia Kanter; Sandra Beltrán; Cristina Castro; Verónica Escudero; Jonay Pantoja; Pablo Molina; Belen Vizcaíno; Mercedes González; Emma Calatayud; Ana Avila Journal: Front Med (Lausanne) Date: 2022-09-26