Healthcare-Related Sociocultural Factors, Racial Disparities, and Kidney Transplant Outcomes in the Kidney Transplant...

Area of Science:

• Nephrology
• Transplantation
• Health Disparities

Background:

• The Kidney Transplant Fast Track (KTFT) program aimed to streamline kidney transplantation (KT) evaluation in the U.S.
• Previous studies indicated KTFT reduced disparities in waitlisting and overall KT receipt.
• This study investigated if race/ethnicity and sociocultural factors independently impacted KT outcomes post-streamlining.

Purpose of the Study:

• To determine if race/ethnicity and sociocultural factors remained associated with time to waitlisting and KT receipt after KT evaluation streamlining.
• To assess if sociocultural factors mediated racial/ethnic differences in KT outcomes.

Main Methods:

• Secondary analysis of the prospective KTFT cohort (N=1108).
• Data collected at baseline (pre-evaluation) and through medical records until 08/2022.
• Hierarchically-adjusted Fine-Gray proportional hazards models were used.

Main Results:

• Medical mistrust was significantly associated with a lower cumulative incidence of waitlisting.
• No other sociocultural factors were independently associated with waitlisting or KT receipt.
• Racial/ethnic differences were observed in KT type: Black participants had higher DDKT incidence, while 'Other' race/ethnicity had lower LDKT incidence compared to White participants.

Conclusions:

• Despite KTFT's success in reducing overall disparities, significant racial/ethnic differences in LDKT and DDKT receipt persist.
• Medical mistrust emerged as a key barrier to kidney transplantation waitlisting.
• Sociocultural factors and race/ethnicity continue to influence KT outcomes even with streamlined evaluation processes.