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Pretransplantation coronavirus disease 2019 vaccination requirements: A matched case-control study of factors
Anya L Edwards1, Mehdi M Tavakol1, Anna Mello1
1Department of Surgery, University of California San Francisco, San Francisco, California, USA.
Abstract:
Numerous United States transplant centers require solid organ transplantation candidates to be vaccinated against the coronavirus disease of 2019 to be active on the United Network for Organ Sharing waiting list. This study examined characteristics of adult patients on one center's kidney transplantation waiting list whose status was inactivated due to a lack of coronavirus disease 2019 vaccination by July 1, 2022, and who did not subsequently provide proof of vaccination by August 31, 2022 (cases). Patients in the control group were retrospectively matched to patients in the case group in a 4-to-1 fashion according to age, sex, and "active" status on the waiting list. Multivariable logistic regression was performed, with race/ethnicity, primary language, health insurance, education, and Vaccine Equity Metric (VEM, a measure of health equity at the zip code level) quartile as covariates. Results revealed that patients from zip codes in the lowest VEM quartile (odds ratio [OR] 1.89; P = .02) and those insured by governmental payors (Medicare: OR, 2.00; P < .01 and Medicaid: OR, 2.89; P < .01) had higher odds of being inactivated than those from zip codes that make up the highest VEM quartile and those insured by commercial payors, respectively. These findings serve as a cautionary tale regarding universal pretransplantation vaccination requirements, which may raise equity concerns that should be considered upon policy implementation.
Insights
Kidney transplant candidates lacking coronavirus disease 2019 vaccination were inactivated. Patients from lower-equity areas and those with government insurance faced higher inactivation odds, highlighting potential transplantation equity concerns.
Area of Science:
- Transplantation Immunology
- Public Health Policy
- Health Equity Research
Background:
- Many US transplant centers mandate coronavirus disease 2019 vaccination for organ transplant candidates.
- Vaccination status is often required for active United Network for Organ Sharing waiting list status.
Purpose of the Study:
- To examine characteristics of kidney transplant candidates inactivated due to lack of coronavirus disease 2019 vaccination.
- To identify factors associated with inactivation among patients on a transplant waiting list.
Main Methods:
- Retrospective case-control study design.
- Matching patients based on age, sex, and active waiting list status.
- Multivariable logistic regression analysis incorporating race/ethnicity, language, insurance, education, and Vaccine Equity Metric (VEM) quartile.
Main Results:
- Patients from lowest VEM quartile zip codes had higher odds of inactivation (OR 1.89, P=.02).
- Patients with Medicare (OR 2.00, P<.01) or Medicaid (OR 2.89, P<.01) insurance had higher odds of inactivation compared to commercially insured patients.
- Higher odds of inactivation were observed for patients from lower socioeconomic status zip codes and those with governmental insurance.
Conclusions:
- Universal pretransplantation vaccination requirements may disproportionately affect vulnerable populations.
- Health equity concerns should be carefully considered during the implementation of vaccination policies for transplant candidates.
- Findings suggest potential disparities in access or adherence to vaccination mandates within the solid organ transplantation waiting list population.
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