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Ethnic Background Is a Potential Barrier to Living Donor Kidney Transplantation in Canada: A Single-Center Retrospective Cohort Study

Mucsi, Istvan MD, PhD; Bansal, Aarushi; Famure, Olusegun; Li, Yanhong; Mitchell, Margot; Waterman, Amy D. PhD; Novak, Marta MD, PhD; Kim, S. Joseph MD, PhD

doi: 10.1097/TP.0000000000001658
Original Clinical Science—General

Background We examined if African or Asian ethnicity was associated with lower access to kidney transplantation (KT) in a Canadian setting.

Methods Patients referred for KT to the Toronto General Hospital from January 1, 2003, to December 31, 2012, who completed social work assessment, were included (n = 1769). The association between ethnicity and the time from referral to completion of KT evaluation or receipt of a KT were examined using Cox proportional hazards models.

Results About 54% of the sample was white, 13% African, 11% East Asian, and 11% South Asian; 7% had “other” (n = 121) ethnic background. African Canadians (hazard ratio [HR], 0.75; 95% CI: 0.62-0.92]) and patients with “other” ethnicity (HR, 0.71; 95% CI, 0.55-0.92) were less likely to complete the KT evaluation compared with white Canadians, and this association remained statistically significant in multivariable adjusted models. Access to KT was significantly reduced for all ethnic groups assessed compared with white Canadians, and this was primarily driven by differences in access to living donor KT. The adjusted HRs for living donor KT were 0.35 (95% CI, 0.24-0.51), 0.27 (95% CI, 0.17-0.41), 0.43 (95% CI, 0.30-0.61), and 0.34 (95% CI, 0.20-0.56) for African, East or South Asian Canadians and for patients with “other” ethnic background, respectively.

Conclusions Similar to other jurisdictions, nonwhite patients face barriers to accessing KT in Canada. This inequity is very substantial for living donor KT. Further research is needed to identify if these inequities are due to potentially modifiable barriers.

Access to kidney transplantation (KT) is significantly reduced for all ethnic groups assessed compared to Caucasian Canadians, and this is primarily driven by differences in access to living donor KT. Further research is needed to identify the causes of inequities. Supplemental digital content is available in the text.

1 Division of Nephrology, Multi-Organ Transplant Program, University Health Network and University of Toronto, Toronto, Canada.

2 Division of Nephrology, David Geffen School of Medicine at the University of California, Los Angeles, CA.

3 Centre for Mental Health, University Health Network and Department of Psychiatry, University of Toronto Toronto, Ontario, Canada.

4 Institute of Behavioral Sciences, Semmelweis University, Budapest, Hungary.

5 Institute of Health Policy, Management and Evaluation, University of Toronto Toronto, Ontario, Canada.

Received 10 September 2016. Revision received 21 December 2016.

Accepted 28 December 2016.

I.M. is the recipient of an unrestricted education grant from Astellas Pharma Canada to support the adaptation of “Explore Transplant” patient education program for Ontario. S.J.K. is the recipient of an unrestricted educational grant from Astellas Pharma Canada to organize an annual conference for Ontario physicians caring for kidney transplant recipients on various clinical topics (eg, skin cancer, bone disease, failing allograft). Other authors of this article have no competing interest to disclose.

I.M., O.F., M.N., and S.J.K. participated in research design. A.B., M.M., O.F., and Y.L. contributed to data abstraction, data entry and data management. A.B., O.F., Y.L., and I.M. contributed to the analysis of the data. I.M., M.N., A.D.W., and S.J.K. contributed to interpretation of the data. All authors participated in drafting and finalizing the article.

Correspondence: Istvan Mucsi, MD, PhD, FRCPC, FASN, Multiorgan Transplant Unit, Toronto General Hospital, University Health Network, PMB 11C-188, 585 University Avenue Toronto, Ontario, Canada M5G 2N2. (istvan.mucsi@utoronto.ca).

Supplemental digital content (SDC) is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal’s Web site (www.transplantjournal.com).

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