Findings from a recent study indicate that Native Americans have reduced access to kidney transplants and are at higher risk to die on the waiting list when compared to white individuals. The study titled “The Difficult Road for Native Americans in Kidney Transplantation: Decreased Access and Reduced Long-Term Survival” was recently presented at ASN Kidney Week 2015 (Nov. 3–8) in San Diego, California.
Researchers from the University of New Mexico led by Sarah Stith, PhD, an applied microeconomist specializing in healthcare, found that while short-term clinical outcomes following kidney transplant were identical, Native Americans had worse long-term survival outcomes than white people.
Chronic kidney disease (CKD) is characterized by permanent kidney damage or decreased level of kidney function that continues for three months or more. When left untreated, CKD can lead to complete kidney failure, with dialysis or kidney transplant accounting for the only treatment options. Recent estimates indicate that 15% of Native Americans have chronic kidney disease (CKD) stages 1–4, with a high incidence of end-stage renal disease. However, this population has low rates of kidney transplantation.
To evaluate such inequalities, the research team reviewed clinical information retrieved from the Organ Procurement and Transplantation Network (OPTN) over a period of 16 years. The analysis included reasons for wait-list removal, rates of survival after kidney transplant and adjusting for factors including patient, donor and match characteristics. Results revealed that Native Americans were less likely to receive a kidney transplant and more likely to die while waiting for one when compared to white individuals. Moreover, in comparison with whites, Native Americans were found to have worse survival rates after kidney transplant at 2 years and 3 years; however, 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, according to a news release. “Native Americans also tend to receive transplants at centers associated with worse outcomes and would benefit disproportionately from receiving transplants at better centers.”