Journal
AMERICAN JOURNAL OF TRANSPLANTATION
Volume 11, Issue 8, Pages 1712-1718Publisher
WILEY-BLACKWELL
DOI: 10.1111/j.1600-6143.2011.03606.x
Keywords
Access to transplantation; allocation; HLA matching; kidney graft survival; kidney transplantation; minorities; policy; racial and ethnic disparities
Categories
Funding
- Scientific Registry of Transplant Recipients [234-2005-37009C]
- Health Resources and Services Administration, US Department of Health and Human Services
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In 2003, the US kidney allocation system was changed to eliminate priority for HLA-B similarity. We report outcomes from before and after this change using data from the Scientific Registry of Transplant Recipients (SRTR). Analyses were based on 108 701 solitary deceased donor kidney recipients during the 6 years before and after the policy change. Racial/ethnic distributions of recipients in the two periods were compared (chi-square); graft failures were analyzed using Cox models. In the 6 years before and after the policy change, the overall number of deceased donor transplants rose 23%, with a larger increase for minorities (40%) and a smaller increase for non-Hispanic whites (whites) (8%). The increase in the proportion of transplants for non-whites versus whites was highly significant (p < 0.0001). Two-year graft survival improved for all racial/ethnic groups after implementation of this new policy. Findings confirmed prior SRTR predictions. Following elimination of allocation priority for HLA-B similarity, the deficit in transplantation rates among minorities compared with that for whites was reduced but not eliminated; furthermore, there was no adverse effect on graft survival.
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