Thomas G. Peters
Racial Disparities and Transplantation
University of Florida Health Science Center
issue american journal kidney diseases weng et al1weng fl joffe mm feldman hi mange kc rates completion medical evaluation renal transplantationam j kidney dis 2005 46 734745abstract full text full text pdf pubmed scopus 84 google scholar report rates completion evaluation process placed cadaveric kidney transplant waiting list authors included 175 patients advanced chronic renal failure soon require dialysis transplantation stable dialysis therapy patients wished evaluated transplantation time completion evaluation placement waiting list longer black patients others questions health care disparity based race naturally arise studythe authors use rather sophisticated statistical analyses arrive conclusion appear included number interesting sociodemographic variables including size referring nephrology group well specific physician transplant coordinator involved evaluation clearly attempt leave stone unturned strength work end point listing patients united network organ sharing unos even potential living donor identified sound study departure many transplant centers listing expense spared living kidney donation plannedunlike many centers 45 patients coming transplant evaluation yet dialysis therapy furthermore patients dialysis therapy relatively new dialysis patients treated median 162 days additionally 175 patients completed study came group 356 initially presented evaluation thus fewer half referred patients completed study know nothing regarding racial composition persons studied event followup period 100 175 patients 57 completed tests placed unos deceased donor renal transplant waiting list strongest associations completing transplant medical evaluation order additional test evaluation needed patient never married insurance coverage initial information transplantation outside medical profession strongest associations completing evaluation medicaid coverage patients seeking donation living donor black race therefore would seem least university pennsylvania school medicine persons complete medical records never married nonmedicaid insurance complete evaluations quickly patients rely medicaid asked living donor blackthis report many others point racial differences renal transplantation american renal transplant professional active clinical care ignorant racial composition disproportionally black patients reaching endstage renal failure country racial disparities virtually every step transplant process reported medicalbiological sociodemographic multifactorial appear complex2epstein ayanian jz keogh jh et alracial disparities access renal transplantationclinically appropriate due underuse overusen engl j med 2000 343 15371544crossref pubmed scopus 489 google scholar 3gadegbeku c freeman agodoa l racial disparities renal replacement therapyj natl med assoc 2002 94 s45s54pubmed google scholar 4sanfilippo fp vaughn wk peters tg et alfactors affecting waiting time cadaveric kidney transplant candidates united statesjama 1992 267 247252crossref pubmed scopus 118 google scholar 5young cj gaston rs renal transplantation black americansn engl j med 2000 343 15451552crossref pubmed scopus 238 google scholar thus circumstances health care disparity renal transplantation may largely beyond control transplant team however physicians must remain ethically committed serve patients equally may able address number issuesit important understand delivery care minority patients often exemplary renal transplantation clearly centers america transplant wait lists exceed 50 black patients perform transplantation proportion well6the organ procurement transplantation network 2005 httpwwwoptnorglatestdatarptdataasp accessed july 10google scholar thus many centers may little disparity one looks real end point renal transplant evaluation course transplanting kidney interestingly weng coauthors also published authors equally sophisticated analysis adherence transplant medication regimens really transplant center dependent race adherence treatment fully considered7weng fl israni ak joffe mm et alrace electronically measured adherence immunosuppressive medications deceased donor renal transplantationj soc nephrol 2005 16 18391848crossref pubmed scopus 157 google scholar words association specific transplant center inherent characteristics treating black recipients appears modify ameliorate racial disparity really somethingthere question larger transplant community addressed issue disparity example removing hlab match priority allocation cadaveric kidneys8united network organ sharing policy 35112 november 19 2004 available httpwwwunosorg accessed july 10 2005google scholar likely favors black patients unos waiting list conversely policy would decrease number transplantations among whites slightly increase rate graft loss9roberts jp wolfe ra bragggresham jl et aleffect changing priority hla matching rates outcomes kidney transplantation minority groupsn engl j med 2004 350 545551crossref pubmed scopus 119 google scholar nonetheless option adopt priority acceptable nationwide despite seemingly clear racial bias positively affecting black potential transplant recipients addition sensitivity transplant community studying outcomes regarding race transplantation shown several interesting beneficial effects single multicenter studies renal transplantation black race9roberts jp wolfe ra bragggresham jl et aleffect changing priority hla matching rates outcomes kidney transplantation minority groupsn engl j med 2004 350 545551crossref pubmed scopus 119 google scholar 10abbott kc sawyers es oliver iii jd et algraft loss due recurrent focal segmental glomerulosclerosis renal transplant recipients united statesam j kidney dis 2001 37 366373abstract full text pdf pubmed scopus 99 google scholar 11fernandezbueno c samimi f reinmuth b et alimproved results cadaveric renal transplantation black recipientstransplant proc 1988 20 398400google scholar 12foster iii ce philosophe b schweitzer ej et ala decade experience renal transplantation africanamericansann surg 2002 236 794805crossref pubmed scopus 65 google scholar 13peters tg shaver tr ames iv je santiagodelpin ea jones kw blanton jw cold ischemia outcome 17937 cadaveric kidney transplantstransplantation 1995 59 191196pubmed google scholar 14swanson sj hypolite io agodoa lyc et aleffect donor factors early graft survival adult cadaveric renal transplantationam j transplant 2002 2 6875crossref pubmed scopus 79 google scholar example black kidney allograft recipients renal failure secondary focal segmental glomerular sclerosis especially living donor allograft improved graft survival decrease graft loss resulting recurrent focal segmental glomerular sclerosis compared whites furthermore donor recipient race matching possibly related hla factors shown advantage outcomes black transplant recipients happily priorities outcomes actually favored minorities least instancesthe results conclusions noted weng et al1weng fl joffe mm feldman hi mange kc rates completion medical evaluation renal transplantationam j kidney dis 2005 46 734745abstract full text full text pdf pubmed scopus 84 google scholar several weaknesses many cite study reflects single referral population small number admit potential confounding well limited ability adjust comorbidity casemix severity additionally complexity endstage renal disease untoward events affecting patients initial consultation need additional testing step evaluation process showed unexpected finding real reason evaluate patients way may influence predictability thus value work may authors found statistical difference increased time evaluation blacks decreased never married persons rather point racial disparity phenomenon even perceived individual practitioners must allowed affect us care weng et al1weng fl joffe mm feldman hi mange kc rates completion medical evaluation renal transplantationam j kidney dis 2005 46 734745abstract full text full text pdf pubmed scopus 84 google scholar offer solution matterthe american medical association currently involved significant effort end disparities delivery health care foster appropriate communication skills among professionals improving health literacy among patients care patients embrace efforts would approach systemrelated problems may inadvertently perpetuate certain aspects disparity making least capable patient partner care goal treating professionals especially care patients highintensity needs dialysis transplantation clearly individual seeks render care biased racially charged manner nonetheless training time demands placed us may unintentional impediments optimal physicianpatient partnership would ultimately diminish racial ethnic disparitiesno study single multicenter confirm disparities may come play regarding clinical sociodemographic matters potentially affecting individual patients really participate ultimate decisions whether transplant referral evaluation organ acceptance occur many reports number appropriately cited weng et al1weng fl joffe mm feldman hi mange kc rates completion medical evaluation renal transplantationam j kidney dis 2005 46 734745abstract full text full text pdf pubmed scopus 84 google scholar regarding renal transplantation black race america studies showed disparities offered real plan solution probably sadly multifactorial sociodemographic problem may single broadly applicable solution many affirm persons rendering care receiving care indeed different context one must wonder certain centers really overcome racial disparity least confirmed studies clearly concerned caregivers racial ethnic backgrounds strive eliminate systemrelated disparity however end also issue patient responsibility professionals caring ill must leave door open receive service must share responsibility full extent possible becoming part medical system imperfect attempting address uncomfortable issues disparate care among groups americans issue american journal kidney diseases weng et al1weng fl joffe mm feldman hi mange kc rates completion medical evaluation renal transplantationam j kidney dis 2005 46 734745abstract full text full text pdf pubmed scopus 84 google scholar report rates completion evaluation process placed cadaveric kidney transplant waiting list authors included 175 patients advanced chronic renal failure soon require dialysis transplantation stable dialysis therapy patients wished evaluated transplantation time completion evaluation placement waiting list longer black patients others questions health care disparity based race naturally arise study authors use rather sophisticated statistical analyses arrive conclusion appear included number interesting sociodemographic variables including size referring nephrology group well specific physician transplant coordinator involved evaluation clearly attempt leave stone unturned strength work end point listing patients united network organ sharing unos even potential living donor identified sound study departure many transplant centers listing expense spared living kidney donation planned unlike many centers 45 patients coming transplant evaluation yet dialysis therapy furthermore patients dialysis therapy relatively new dialysis patients treated median 162 days additionally 175 patients completed study came group 356 initially presented evaluation thus fewer half referred patients completed study know nothing regarding racial composition persons studied event followup period 100 175 patients 57 completed tests placed unos deceased donor renal transplant waiting list strongest associations completing transplant medical evaluation order additional test evaluation needed patient never married insurance coverage initial information transplantation outside medical profession strongest associations completing evaluation medicaid coverage patients seeking donation living donor black race therefore would seem least university pennsylvania school medicine persons complete medical records never married nonmedicaid insurance complete evaluations quickly patients rely medicaid asked living donor black report many others point racial differences renal transplantation american renal transplant professional active clinical care ignorant racial composition disproportionally black patients reaching endstage renal failure country racial disparities virtually every step transplant process reported medicalbiological sociodemographic multifactorial appear complex2epstein ayanian jz keogh jh et alracial disparities access renal transplantationclinically appropriate due underuse overusen engl j med 2000 343 15371544crossref pubmed scopus 489 google scholar 3gadegbeku c freeman agodoa l racial disparities renal replacement therapyj natl med assoc 2002 94 s45s54pubmed google scholar 4sanfilippo fp vaughn wk peters tg et alfactors affecting waiting time cadaveric kidney transplant candidates united statesjama 1992 267 247252crossref pubmed scopus 118 google scholar 5young cj gaston rs renal transplantation black americansn engl j med 2000 343 15451552crossref pubmed scopus 238 google scholar thus circumstances health care disparity renal transplantation may largely beyond control transplant team however physicians must remain ethically committed serve patients equally may able address number issues important understand delivery care minority patients often exemplary renal transplantation clearly centers america transplant wait lists exceed 50 black patients perform transplantation proportion well6the organ procurement transplantation network 2005 httpwwwoptnorglatestdatarptdataasp accessed july 10google scholar thus many centers may little disparity one looks real end point renal transplant evaluation course transplanting kidney interestingly weng coauthors also published authors equally sophisticated analysis adherence transplant medication regimens really transplant center dependent race adherence treatment fully considered7weng fl israni ak joffe mm et alrace electronically measured adherence immunosuppressive medications deceased donor renal transplantationj soc nephrol 2005 16 18391848crossref pubmed scopus 157 google scholar words association specific transplant center inherent characteristics treating black recipients appears modify ameliorate racial disparity really something question larger transplant community addressed issue disparity example removing hlab match priority allocation cadaveric kidneys8united network organ sharing policy 35112 november 19 2004 available httpwwwunosorg accessed july 10 2005google scholar likely favors black patients unos waiting list conversely policy would decrease number transplantations among whites slightly increase rate graft loss9roberts jp wolfe ra bragggresham jl et aleffect changing priority hla matching rates outcomes kidney transplantation minority groupsn engl j med 2004 350 545551crossref pubmed scopus 119 google scholar nonetheless option adopt priority acceptable nationwide despite seemingly clear racial bias positively affecting black potential transplant recipients addition sensitivity transplant community studying outcomes regarding race transplantation shown several interesting beneficial effects single multicenter studies renal transplantation black race9roberts jp wolfe ra bragggresham jl et aleffect changing priority hla matching rates outcomes kidney transplantation minority groupsn engl j med 2004 350 545551crossref pubmed scopus 119 google scholar 10abbott kc sawyers es oliver iii jd et algraft loss due recurrent focal segmental glomerulosclerosis renal transplant recipients united statesam j kidney dis 2001 37 366373abstract full text pdf pubmed scopus 99 google scholar 11fernandezbueno c samimi f reinmuth b et alimproved results cadaveric renal transplantation black recipientstransplant proc 1988 20 398400google scholar 12foster iii ce philosophe b schweitzer ej et ala decade experience renal transplantation africanamericansann surg 2002 236 794805crossref pubmed scopus 65 google scholar 13peters tg shaver tr ames iv je santiagodelpin ea jones kw blanton jw cold ischemia outcome 17937 cadaveric kidney transplantstransplantation 1995 59 191196pubmed google scholar 14swanson sj hypolite io agodoa lyc et aleffect donor factors early graft survival adult cadaveric renal transplantationam j transplant 2002 2 6875crossref pubmed scopus 79 google scholar example black kidney allograft recipients renal failure secondary focal segmental glomerular sclerosis especially living donor allograft improved graft survival decrease graft loss resulting recurrent focal segmental glomerular sclerosis compared whites furthermore donor recipient race matching possibly related hla factors shown advantage outcomes black transplant recipients happily priorities outcomes actually favored minorities least instances results conclusions noted weng et al1weng fl joffe mm feldman hi mange kc rates completion medical evaluation renal transplantationam j kidney dis 2005 46 734745abstract full text full text pdf pubmed scopus 84 google scholar several weaknesses many cite study reflects single referral population small number admit potential confounding well limited ability adjust comorbidity casemix severity additionally complexity endstage renal disease untoward events affecting patients initial consultation need additional testing step evaluation process showed unexpected finding real reason evaluate patients way may influence predictability thus value work may authors found statistical difference increased time evaluation blacks decreased never married persons rather point racial disparity phenomenon even perceived individual practitioners must allowed affect us care weng et al1weng fl joffe mm feldman hi mange kc rates completion medical evaluation renal transplantationam j kidney dis 2005 46 734745abstract full text full text pdf pubmed scopus 84 google scholar offer solution matter american medical association currently involved significant effort end disparities delivery health care foster appropriate communication skills among professionals improving health literacy among patients care patients embrace efforts would approach systemrelated problems may inadvertently perpetuate certain aspects disparity making least capable patient partner care goal treating professionals especially care patients highintensity needs dialysis transplantation clearly individual seeks render care biased racially charged manner nonetheless training time demands placed us may unintentional impediments optimal physicianpatient partnership would ultimately diminish racial ethnic disparities study single multicenter confirm disparities may come play regarding clinical sociodemographic matters potentially affecting individual patients really participate ultimate decisions whether transplant referral evaluation organ acceptance occur many reports number appropriately cited weng et al1weng fl joffe mm feldman hi mange kc rates completion medical evaluation renal transplantationam j kidney dis 2005 46 734745abstract full text full text pdf pubmed scopus 84 google scholar regarding renal transplantation black race america studies showed disparities offered real plan solution probably sadly multifactorial sociodemographic problem may single broadly applicable solution many affirm persons rendering care receiving care indeed different context one must wonder certain centers really overcome racial disparity least confirmed studies clearly concerned caregivers racial ethnic backgrounds strive eliminate systemrelated disparity however end also issue patient responsibility professionals caring ill must leave door open receive service must share responsibility full extent possible becoming part medical system imperfect attempting address uncomfortable issues disparate care among groups americans rates completion medical evaluation renal transplantationamerican journal kidney diseasesvol 46issue 4previewbackground failure complete medical evaluation renal transplantation may impede access transplantation preclude possibility preemptive transplantation sought 1 characterize completion rates transplantation medical evaluation 2 determine factors associated completion evaluation hypothesized patients dialysis therapy complete evaluation process quickly patients receiving dialysis methods september 2002 september 2003 total 175 patients evaluated renal transplantation hospital university pennsylvania enrolled prospective cohort study fulltext pdf