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Evolving Trends in Racial Disparities for Peri-Operative Outcomes with the New Kidney Allocation System (KAS) Implementation

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Abstract

Introduction

To improve kidney transplant allocation equitability, a new Kidney Allocation System (KAS) was implemented December 4, 2014. The purpose of this study was to determine if the impact of KAS on peri-operative outcomes differed by recipient race/ethnicity.

Methods

This was a time series analysis using data aggregated in monthly intervals from October 2012 through September 2015 using the University HealthSystem Consortium (UHC). This includes national data aggregated at the center level of all US kidney transplant centers that participate in the UHC (416 centers). Segmented regression with interaction terms was used to determine the impact of KAS on outcomes and differences by race/ethnicity.

Results

A total of 28,809 deceased donor kidney transplants were included with 25 months of pre-KAS data and 10 months of post-KAS data. After KAS implementation, the estimated transplant rate per month decreased significantly for Caucasians by 17.6 cases per month (p = 0.0001), and increased significantly for AAs by 37.8 (p = 0.0001), Hispanics by 16.3 (p = 0.0001), and other races by 8.2 cases per month (p = 0.0001). Delayed graft function, 7- and 14-day readmissions significantly increased after KAS, which did not differ by race. Hispanics saw a 7.7% decrease in ICU admissions after KAS, which differed as compared to other racial/ethnic cohorts (p = 0.0026). Costs of kidney transplantation increased significantly after KAS in all groups except Hispanics. Mortality, length of stay, in-hospital complications, and 30-day readmissions were not significantly impacted by KAS, also not differing by race/ethnicity.

Conclusion

KAS had substantial impact on transplant rates by race/ethnicity. KAS also led to increased costs, readmissions, and delayed graft function (DGF) across all racial/ethnic groups. The impact of KAS on ICU cases solely within Hispanics requires further investigation into potential etiologies.

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Acknowledgements

Medical University of South Carolina Department of Surgery and Medical University of South Carolina College of Medicine Alumni Association were acknowledged. This research was supported through grants from the National Institute of Diabetes and Digestive and Kidney Diseases under Award Numbers K23DK099440 and T35DK007431.

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Authors and Affiliations

  1. College of Medicine, MUSC, Charleston, SC, 29425, USA

    Daisy Sanchez & Baliga Prabhakar

  2. Department of Transplant Surgery, MUSC, Charleston, SC, USA

    Derek Dubay & David J. Taber

  3. Ralph H Johnson, VAMC, Charleston, SC, USA

    David J. Taber

Authors
  1. Daisy Sanchez
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  2. Derek Dubay
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  3. Baliga Prabhakar
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  4. David J. Taber
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Correspondence to Daisy Sanchez.

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Sanchez, D., Dubay, D., Prabhakar, B. et al. Evolving Trends in Racial Disparities for Peri-Operative Outcomes with the New Kidney Allocation System (KAS) Implementation. J. Racial and Ethnic Health Disparities 5, 1171–1179 (2018). https://doi.org/10.1007/s40615-018-0464-3

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  • DOI: https://doi.org/10.1007/s40615-018-0464-3

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