African Canadian and Asian Canadian patients are less likely to have potential living donors when first presenting for evaluation: A single center experience

Priscilla Yung1, Clarrissa Cremin-Endes1, Aarushi Bansal1, Amy D. Waterman2, Olusegun Famure1, S. Joseph Kim1, Istvan Mucsi1

African Canadian and Asian Canadian patients are less likely to have potential living donors when first presenting for evaluation: A single center experience

1 Division of Nephrology, Multi-Organ Transplant Program, University Health Network and University of Toronto, Toronto, Canada.

2 Division of Nephrology, David Geffen School of Medicine at the University of California, Los Angeles, CA, USA

 

Background: Research has shown that Canadian patients who belong to visible minorities may have less access to living donor kidney transplant compared to their Caucasian counterparts but there is a general paucity of data in this area. To better understand these disparities, we examined the association between ethnicity and having a potential living donor identified at the time of first encounter with the transplant center.

Methods: We conducted a single-centre retrospective cohort study of 553 adult patients  referred for kidney transplantation between January 1, 2009 and December 31, 2013. Data was extracted from the patients` medical record. Only patients for whom data about ethnicity was available (n=553) were included. Univariable and multivariable associations between ethnicity and whether a potential living donor was identified were explored using logistic regression models.

Results: The mean (±SD) age was 50.0 (±13.8) years, 59% were male, and 44% had a history of diabetes. Fifty-two percent of the patients were white, 13% black, 15% Asian and 20% “other race”. Fifty-five percent of patients had at least one potential living donor identified at the time of first encounter with the transplant center. Asian patients had 67% lower odds (95% CI 0.20 – 0.56), while black patients had 55% lower odds (95% CI 0.27 – 0.77) than whites for having a living donor identified. These associations remained significant even after adjusting for age, gender, comorbidities (diabetes, heart disease and stroke), not being able to communicate in English and marital status. 

Conclusions: With Black and Asian patients presenting with fewer potential living donors for transplant evaluation and ultimately receiving fewer living donor kidney transplants, we need to learn more about specific factors contributing to these disparities in access to kidney transplantation and help patients overcome potentially modifiable barriers to living donor kidney transplant.

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