Differences in access to cadaveric renal transplantation in the United States

This national study compares waitlisting and transplantation rates by gende r, race, and diabetes and evaluates physiologic factors (panel-reactive ant ibodies [PRA], blood type, HLA matchability) and related practices (early a nd multiple waitlisting) as explanatory factors. This longitudinal study of the time to transplant waitlisting among 228,552 incident end-stage renal disease (ESRD) dialysis patients and to cadaveric transplantation among 46, 164 waitlist dialysis patients (n = 23,275 first cadaveric transplants) use d US data for 1991 to 1997. Relative rates of waitlisting (RRWL) after ESRD onset and of cadaveric transplantation (RRTx) after waitlist (Cox proporti onal hazards models) were adjusted for age, race, sex, ESRD cause, region, and incidence/waitlist year. We found that women have an RRWL = 0.84 (P < 0 .0001) and RRTx = 0.86 (P < 0.0001). PRA levels can explain the difference in the transplantation rate, because accounting for PRA gives an adjusted R RTx = 0.98 (NS) for women. For blacks versus whites, the RRWL = 0.59 (P < 0 .0001) and RRTx = 0.55 (P < 0.0001). However, the transplantation rate can only partly be explained by ABO types, rare HLA types, and early and multip le waitlisting (adjusted RRTx = 0.67 [P < 0.0001]). For diabetes versus glo merulonephritis, the RRWL = 0.52 (P < 0.0001) and RRTx = 0.98 (NS). Older p atients (40 to 59 years of age) are less likely to be waitlisted and to rec eive a transplant after waitlisting (RRWL = 0.57 [P < 0.0001], RRTx = 0.88 [P < 0.0001]) versus younger patients (ages 18 to 39 years). These results indicate substantial differences by age, sex, race, and diabetes in rates o f waitlisting for transplantation and by age and race for transplantation a fter waitlisting. These differences by race were not explained by referral practices or the physiologic factors studied here. (C) 2000 by the National Kidney Foundation, Inc.