Geospatial Insights into Access to Kidney Transplantation in Underserved Hispanic Communities

The rising Hispanic population in the U.S. is at significant end-stage kidney disease (ESKD) risk. However, Hispanic communities face notable challenges in kidney transplantation access. We aimed to identify U.S. regions that might lack kidney transplant centers (KTCs) actively engaging Hispanic individuals living with ESKD.

We identified location of U.S. KTCs using the UNOS database from 2018 to 2022. We examined county-level prevalence and mortality of adult Hispanic individuals living with ESKD from the 2021 public USRDS dataset. We performed geospatial analysis to characterize the Hispanic population within a two-hour drive from each KTC, and identified statistically significant spatial hot and cold spot clustering for our variables of interest. Additionally, we identified KTCs with dedicated Hispanic kidney clinics (H-KTC) and analyzed pre- and post-implementation transplantation rates.

We included 196 KTCs and 11 H-KTCs. Geospatial analysis showed that there was a higher proportion of Hispanic individuals living with ESKD outside the two-hour driving zone than within the two-hour driving zone (0.23% vs. 0.21. Death count among Hispanic individuals living with ESKD was 11.4% outside vs. 10.2% within 2-h driving zone, with mortality rate > 10Std-Dev in some south-west regions of US out of the 2 h-driving zones. After H-KTC implementation, the median transplants per center among Hispanic recipients increased from 81 [IQR 58-146.5] to 109 [IQR 66-178.5] (p = 0.006).

Although the existing KTCs serving Hispanic populations are located within strategic geographic locations, there are still areas with a high prevalence of Hispanic individuals living with ESKD with limited access to KTCs. These populations might benefit from extensive outreach from new or existing KTCs.