New research finds disparity in post-transplant survival between Native Americans and whites

Native Americans have decreased access to kidney transplants and are more likely to die on the waiting list than whites according to new research presented at ASN Kidney Week 2015 held November 3-8 in San Diego, CA. Researchers also found that while short-term outcomes after receiving a kidney transplant were similar, Native Americans had worse long-term survival outcomes compared to whites.

Native Americans are at increased risk for developing kidney disease, with the most-recent data estimating 15% of Native Americans have chronic kidney disease (CKD) stages 1-4. This population also has high rates of end-stage renal disease and lower rates of kidney transplantation. To examine these disparities, University of New Mexico researchers led by Sarah Stith, PhD, an applied microeconomist specializing in health care, reviewed data from the Organ Procurement and Transplantation Network (OPTN) over a 16-year period.

After analyzing wait-list removal reasons, post-transplant survival rates, and controlling for multiple factors (such as patient, donor, match characteristics), they found Native Americans were less likely to receive a kidney transplant (odds ratio [OR] 0.71 [95% CI 0.64-0.80]) and more likely to die while waiting for one (OR 1.88 [95% 0.89-3.94) than white individuals.

Although Native Americans demonstrated worse post-transplant survival at 2 years (OR 0.80 [95% CI 0.70-0.92]) and 3 years (OR 0.81 [95% CI 0.71-0.94]) compared to whites, this difference was not statistically significant.

"The decomposition of our results indicates that the disparity in 3-year post-transplant survival between Native Americans and whites is driven primarily by the prevalence of lower quality donors among Native Americans and a greater negative impact from such donor characteristics on survival among Native Americans," the authors concluded. "Native Americans also tend to receive transplants at centers associated with worse outcomes and would benefit disproportionately from receiving transplants at better centers."