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Population Health, Ethnicity, and Rate of Living Donor Kidney Transplantation

Reed, Rhiannon D.1; Sawinski, Deirdre, MD2; Shelton, Brittany A.1; MacLennan, Paul A., PhD1; Hanaway, Michael, MD1; Kumar, Vineeta, MD3; Long, Dustin, PhD4; Gaston, Robert S., MD3; Kilgore, Meredith L., PhD5; Julian, Bruce A., MD3; Lewis, Cora E., MD6; Locke, Jayme E., MD1

doi: 10.1097/TP.0000000000002286
Original Clinical Science—General

Background Living donor kidney transplantation has declined in the United States since 2004, but the relationship between population characteristics and rate of living donation is unknown. The goal of our study was to use data on general population health and socioeconomic status to investigate the association with living donation.

Methods This cross-sectional, ecological study used population health and socioeconomic status data from the CDC Behavioral Risk Factor Surveillance System to investigate the association with living donation. Transplant centers performing 10 or greater kidney transplants reported to the Scientific Registry of Transplant Recipients in 2015 were included. Center rate of living donation was defined as the proportion of all kidney transplants performed at a center that were from living donors.

Results In a linear mixed-effects model, a composite index of health and socioeconomic status factors was negatively associated with living donation, with a rate of living donation that was on average 7.3 percentage points lower among centers in areas with more comorbid disease and poorer socioeconomic status (95% confidence interval, −12.2 to −2.3, P = 0.004). Transplant centers in areas with higher prevalence of minorities had a rate of living donation that was 7.1 percentage points lower than centers with fewer minorities (95% confidence interval, −11.8 to −2.3, P = 0.004).

Conclusions Center-level variation in living donation was associated with population characteristics and minority prevalence. Further examination of these factors in the context of patient and center-level barriers to living donation is warranted.

The factor which has a negative impact on living donation is investigated and the rate of living donation is significantly lower in areas with more comorbid disease, poorer socioeconomic status, and in areas with higher prevalence of minorities.

1 Department of Surgery, University of Alabama at Birmingham Comprehensive Transplant Institute, Birmingham, AL.

2 Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.

3 Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL.

4 Department of Biostatistics, University of Alabama at Birmingham School of Public Health, Birmingham, AL.

5 Department of Health Care Organization and Policy, University of Alabama at Birmingham School of Public Health, Birmingham, AL.

6 Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL.

Received 30 January 2018. Revision received 8 April 2018.

Accepted 28 April 2018.

This research was supported in part by the National Institutes of Health grant numbers K23-DK103918 (PI: Locke) and R01-DK113980 (PI: Locke). The data reported here have been supplied by the Minneapolis Medical Research Foundation (MMRF) as the contractor for the Scientific Registry of Transplant Recipients (SRTR). The interpretation and reporting of these data are the responsibility of the authors and in no way should be seen as an official policy of or interpretation by the SRTR or US Government. These data were presented in preliminary form at the 2017 American Transplant Congress in Chicago, IL.

The authors declare no conflicts of interest.

R.D.R., D.S., B.A.S., P.A.M., J.E.L. participated in research idea and study design. R.D. R. participated in data acquisition. R.D.R., D.S., B.A.S., P.A.M., C.E.L., J.E.L. participated in data analysis/interpretation. R.D.R. and D.L. participated in statistical analysis. D.S., P.A.M., M.H., V.K., D.L., R.G., M.K., B.J., C.E.L., J.E.L. participated in supervision or mentorship. Each author contributed important intellectual content during article drafting and accepts accountability for the overall work by ensuring that questions pertaining to the accuracy or integrity of any portion of the work are appropriately investigated or resolved.

Correspondence: Jayme E. Locke, MD, University of Alabama at Birmingham, 701 19th St, South, LHRB 748, Birmingham, AL 35294. (jlocke@uabmc.edu).

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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