RESEARCH & EDUCATION
CTI INVESTIGATORS EVALUATE RACIAL DISPARITIES IN LIVING-DONOR KIDNEY TRANSPLANTATION
Are racial disparities in living-donor kidney transplantation ( LDKT ) independent of community-level vulnerability ? That was the question asked by UAB Comprehensive Transplant Institute ( CTI ) investigators in a study published in JAMA Surgery in September 2021 .
UAB Medicine General Surgery Resident Cozette Killian , MD ; CTI Director Jayme Locke , MD , MPH ; and others published “ Evaluation of Community-Level Vulnerability and Racial Disparities in Living Donor Kidney Transplant ”. The study was conducted alongside staff from the CTI ’ s Transplant Epidemiology and Analytics in Medicine ( T . E . A . M .) lab .
“ Social determinants of health must be addressed to improve access to LDKT , but these data suggest that addressing this alone will not eliminate racial disparities in LDKT ,” Dr . Killian says . “ We need to be cognizant of the possible ways in which the health care system contributes to these disparities .”
Dr . Locke , the senior author , suggests that implicit biases among transplant providers should be examined as a possible explanation for the authors ’ findings .
RESEARCH & EDUCATION
Understanding that racial disparities in LDKT – the best treatment for end-stage kidney disease – have increased the last two decades and are not explained by patient-level differences , the authors sought to evaluate racial disparities while accounting for the community environments in which patients live .
This retrospective , multicenter , cross-sectional study included data from 19,287 adult kidney-only transplant recipients in the Scientific Registry of Transplant Recipients ( SRTR ) who underwent transplant in 2018 . It looked at both living-donor and deceased-donor kidney transplants . The SRTR data were linked to recipient ZIP codes and to the Centers for Disease Control & Prevention ’ s Social Vulnerability Index ( SVI ).
While living in more vulnerable communities decreased access to LDKT , community vulnerability did not explain racial disparities . Kidney recipients from racial minority groups were less likely to receive LDKT compared to white counterparts , even after accounting for communitylevel vulnerability and patient-level characteristics .
The study also found that the disparity in LDKT between African American / Black ( AAB ) and white recipients increased with greater community vulnerability . In the most vulnerable communities , AAB recipients were 48 % less likely to receive LDKT . Even in the least vulnerable areas – such as Beverly Hills , Calif . – AAB recipients were 24 % less likely to receive LDKT compared to white recipients .
“ Social determinants of health must be addressed to improve access to LDKT , but these data suggest that addressing this alone will not eliminate racial disparities in LDKT . We need to be cognizant of the possible ways in which the health care system contributes to these disparities .”
Cozette Killian , MD , UAB Medicine General Surgery Resident
“ Implicit racial biases , exacerbated by poverty biases , may be impacting physician decision-making during living kidney donor evaluations ,” Dr . Locke says . “ Given the 95 % racial concordance between LDKT recipients and their donors , these decisions may be inadvertently perpetuating racial disparities in LDKT .”
After publication , JAMA Surgery explored the study further as part of an Author Interview podcast . uabmedicine . org / refertransplant 15