Association of Race/Ethnicity on Resolving Inactive Kidney Transplant Status Prior to COVID-19

Minority waitlisted kidney patients are less likely to resolve an inactive status change. We investigate race/ethnicity-based differences in the reasons for and resolution of waitlist inactivation.

The Organ Procurement and Transplantation Network database was queried (December 2014-January 2020). Cause-specific Cox regression and competing risks analysis were conducted to determine the association of inactive status and race/ethnicity, stratified by specific reasons a patient was made inactive.

Of the 94,035 patients, 52.5% experienced inactivity. 47.0% were White, 26.2% were Black, and 17.3% were Hispanic. Black and Hispanic patients experiencing an inactive status change were less likely to receive a transplant (White: 43.3%, Black: 27.1%, Hispanic: 30.4%). We analyzed the most common reasons for inactive status: incomplete workup (44.0%), temporarily too sick (25.1%), and insurance issues (11.9%), and analyzed inactive to active transitions. Overall, from the cause-specific Cox regression analysis, we found that there were significant differences in inactive to active transitions: White versus Black (hazard ratio [HR]: 1.19 [1.15, 1.23]), Hispanic versus White (HR: 0.69[0.66, 0.71]), and Hispanic versus Black (HR: 0.82[0.78, 0.85]). For individuals made inactive for incomplete workup, Hispanics had the lowest probability of converting to active status: Hispanic versus White (HR: 0.63[0.60, 0.67]) and Hispanic versus Black (HR: 0.71[0.67, 0.76]). The competing risk analyses yielded conclusions consistent with those of the cause-specific analysis.

There are significant racial/ethnic differences in the ability to resolve inactive status. Developing targeted interventions by key stakeholders involved with waitlisted patients may help address this health disparity.