Disparities in Access to Preemptive Repeat Kidney Transplant: Still Missing the Mark?

Area of Science:

• Nephrology
• Transplant Surgery
• Health Services Research

Background:

• The incidence of kidney allograft failure and the need for repeat transplantation are rising.
• The benefits of preemptive kidney retransplant (PKre-T) are debated, and its utilization among marginalized populations is unclear.
• Existing disparities in first-time preemptive transplantation suggest potential inequities in PKre-T access.

Purpose of the Study:

• To investigate the existence and nature of inequities in access to preemptive kidney retransplant (PKre-T).
• To determine the association between PKre-T and patient and graft survival outcomes.
• To identify predictors of receiving a PKre-T.

Main Methods:

• A cohort study utilizing the Scientific Registry of Transplant Recipients (SRTR) database from 2000-2018.
• Inclusion of adult patients undergoing primary live or deceased donor kidney transplantation.
• Multivariable logistic regression and Cox proportional hazards models were used to analyze predictors and outcomes of PKre-T versus non-preemptive retransplant.

Main Results:

• 15.5% of patients received PKre-T, while 19.1% received a first preemptive kidney transplant (PKT).
• Significant inequities in PKre-T access were observed based on employment status, education level, race (Black vs. White), and sex (women more likely than men).
• PKre-T was associated with significantly improved graft survival compared to retransplantation following dialysis.

Conclusions:

• Despite demonstrating superior graft survival benefits, access to PKre-T is inequitable.
• Patients with lower socioeconomic status, Black patients, and men face barriers to receiving PKre-T.
• Addressing these disparities is crucial to ensure equitable access to life-saving kidney retransplantation.