Ethnicity as a potential barrier to pre-transplant evaluation completion in a Canadian setting

Aarushi Bansal1, Michael Jeanette1, Marta Novak2, Amy Waterman3, Olusegun Famure1, Joseph S. Kim1, Istvan Mucsi1

Ethnicity as a potential barrier to pre-transplant evaluation completion in a Canadian setting

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

2 Department of Psychiatry, University Health Network and University of Toronto, Canada

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

Background: Evidence from the US indicates that whites are more likely to complete the pre-transplant evaluation (PTE) process than blacks. We examined the association between ethnicity and the likelihood of obtaining a final disposition (FD) (i.e., transplant suitability, waitlist activation, or living donor transplant).

Methods: This is a single-centre retrospective cohort study of adult patients referred for kidney transplantation at Toronto General Hospital from January 1, 2003 to December 31, 2013, and followed up until June 30, 2014. Only patients who completed a social work assessment and for whom data about ethnicity was available (n=1355) were included. Obtaining FD within four years after referral was used as the primary outcome variable. Univariable and multivariable associations between ethnicity and time from referral to FD were explored using Cox proportional hazards models.

Results: The mean (±SD) age was 48.7 (±13.6) years, 60% were male, and 40% had a history of diabetes. Fifty-nine percent of the patients were white, 14% black, 12% East Asian, and 11% Indo-Asian. Eighty-six percent of patients received final dispositions within four years of referral. Whites were 23% more likely to obtain a final disposition (p=0.0006) than other ethnicities. In a univariable Cox analysis, black patients were 19% (HR 0.81; 95% CI 0.68-0.96) less likely to complete the PTE. The difference was not significant for East Asians (HR 0.90; 95% CI 0.77-1.10) or Indo-Asians (HR 0.85; 95% CI 0.70-1.04). These results remained unchanged after adjusting for socio-demographic characteristics and comorbidity.

Conclusions: Ethnicity is a potential barrier to PTE completion in a Canadian cohort. Blacks were less likely to complete their PTE compared to whites. East and Indo-Asian patients were not significantly different, although this might be related to insufficient power. We are initiating further studies to identify specific barriers contributing to these disparities in transplant access.

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