CHICAGO — As the demand for kidney transplants for patients with end-stage renal disease continues to increase, disparities in transplantation rates among U.S. minority populations continue.
Dr. Robert S. Gaston, a nephrologist whose transplant team at the University of Alabama, Birmingham, has performed more than 7,000 kidney transplants, said that thousands of people have asked him when they can have a transplant.
Most patients would prefer having a kidney transplant to remaining on dialysis.
“Patients will tell us a lot about therapeutic modalities if we'll listen to them,” Dr. Gaston said at a meeting on clinical nephrology sponsored by the National Kidney Foundation.
The prevalence of end-stage renal disease (ESRD) is four to five times greater in blacks than in whites, yet black and other minority patients do not undergo nearly as many transplants as white patients do. “White patients are 50% more likely to receive a transplant within 2 years of being wait-listed,” compared with other racial groups, Dr. Gaston said.
He cited 2002 data on ESRD prevalence that further underscore the disparities. At that time, more than 80% of the African American population with ESRD was on dialysis, while less than 20% had undergone a kidney transplant. At the same time, only 62% of the comparable white population was on dialysis, while 38% had received a kidney transplant.
All patients who might need a kidney transplant go through a process that involves a referral to a transplant center and a medical evaluation, Dr. Gaston explained. Patients who are approved after the evaluation are then placed on a waiting list. But the process goes more smoothly for some patients than others. “At each step along the pathway, the evaluation process can be challenging,” he said.
Dr. Gaston provided details on many of the barriers to transplantation that minority patients face.
First, fewer African American patients than white patients learn about the transplantation option.
In addition, the high cost of a transplant is also an important factor, and patients with higher-paying private insurance are much more likely to get a transplant than patients who have only Medicare.
Also, those ESRD patients who have been placed on multiple transplant lists have an increased likelihood of ultimately receiving a transplant. But African American patients are 70% less likely to be on multiple waiting lists.
Possibly the biggest obstacle to receiving a transplant is that minority patients have less access to living donors than white patients do. Dr. Gaston cited a study done at his institution that revealed that while 33% of white patients received a kidney from a living donor, only 13% of African American patients were able to undergo this type of transplant.
Ultimately, patients who receive a transplanted kidney from a living donor have the best outcomes. Studies show that the greatest survival benefit occurs in ESRD patients who receive a living donor transplant before starting dialysis.
Under the new organ allocation system, Dr. Gaston noted, transplant access for minorities has increased and overall outcomes have also improved.
Data show a 10.3% increase in renal transplants in black patients since the rules have changed by relaxing HLA matching requirements, said Friedrich K. Port, president of University Renal Research and Education Association in Ann Arbor, Mich.