By Monica Smith
CLEARWATER BEACH, Fla.—A 2014 revision of the Kidney Allocation System (KAS) by the Organ Procurement and Transplantation Network (OPTN), intended to enhance equity in organ allocation and improve patient outcomes, appears to have achieved this goal, according to new research presented at the 2024 Southeastern Surgical Congress.
Historically, while non-white patients have a higher burden of end-stage renal disease, they are less likely than white patients to undergo kidney transplantation. To assess the effectiveness of the KAS revision in addressing the disparities of kidney allocation, researchers at Howard University, in Washington, D.C., conducted a retrospective review of the OPTN/Scientific Registry of Transplant Recipients database from 1998 to 2022, comparing data before and after the revision.
“The objective of our study was to assess the impact of KAS revision on renal transplantation demographics and outcomes, comparing recipients and donor characteristics as well as outcomes, including graft failure pre- and post-KAS revision,” said study researcher Eunice Odusanya, a third-year medical student at Howard.
They found the post-revision patient pool to be older than pre-revision patients, averaging 53 versus 48 years in the earlier group. There were more Medicare and Medicaid recipients in the post-revision period.
“Importantly, we found the KAS revision led to greater ratio of ethnic diversity, with more minority groups having access to kidney transplantation in the post-revision group,” Ms. Odusanya said, noting that the proportion of kidney transplants among Black patients increased from 23% to 27%
The proportion of Black donors, however, remained static at about 12% both pre- and post-revision. “This highlights the need to improve or encourage kidney donation among Black communities,” she said.
The researchers also assessed the flow of kidneys from donors to recipients by ethnicity and found that 54% of white donors donate to white recipients, 55% of Black donors donate to Black recipients, and 48% of Hispanics donate to Hispanic recipients.
“This suggests the probability that with more donations from minority groups, there will be more organs allocated to minority recipients,” Ms. Odusanya said.
In terms of outcomes—specifically graft failure—after adjusting for patient age, sex, body mass index and donor kidney function, the researchers found a 9% decrease in the risk for graft failure across race and ethnic groups. This outcome was most pronounced in white and Black patients.
“We’re hoping that in the future there will be more efforts toward improving equity, especially with minority groups,” Ms. Odusanya concluded. “As we saw, Black donations didn’t change, so encouraging more resources, education, talking to patients about the fact that kidney transplant has benefits over dialysis in terms of quality of life, cost and economic burden to the healthcare system, [all of] that could convince them to commit to transplantation or to get on the waitlist immediately on starting dialysis.”
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