For patients with end-stage kidney disease (ESKD), kidney transplantation (KT) and particularly living-donor kidney transplantation (LDKT) is considered the best available treatment. Even so, not all ethnocultural groups in North America are pursuing transplant at equal rates, and these differences are especially notable in regard to LDKT. American studies have found that visible minority groups such as African Americans, Hispanics, and Native Americans have lower rates of KT and LDKT than white Americans. Since no similar studies had been done recently in Canada, our research sought to determine whether being of African Canadian, Chinese Canadian, or South Asian (Indian, Pakistani, or Sri Lankan) ethnicity was associated with lower access to living donor kidney transplant. Our results were published in the April 2017 issue of Transplantation journal.
For Canadian ESKD patients of African or Asian ethnicity, reduced access to KT leads to poorer health and quality of life. But evidence suggests that we can work with these patients to overcome certain barriers to transplant, such as knowledge.
Our project studied 1,769 potential KT recipients who had been referred to Toronto General Hospital for KT evaluation between 2003 and 2012. When patients are evaluated for KT, they typically meet with a transplant coordinator, a social worker, and a nephrologist as part of their assessment. In our study, we tracked the time between when patients underwent their social work assessment and when they either completed their KT evaluation, or received a transplant.
We found that patients of African Canadian ethnicity were significantly less likely to complete the KT evaluation compared with white Canadians. We also found that African Canadians, Chinese Canadians and South Asians experienced significantly lower rates of LDKT relative to white Canadians. Finally, these same three groups were significantly less likely to receive a KT overall, from either a deceased or a living donor. Thus, our results suggest that ethnic background represents an important barrier to accessing both KT and LDKT in a Canadian setting.
Next research steps
For Canadian ESKD patients of African or Asian ethnicity, reduced access to KT leads to poorer health and quality of life as well as shortened life expectancy. But evidence suggests that we can work with these patients to overcome certain barriers to transplant, such as knowledge about transplant options. For instance, our team’s recent Explore Transplant Ontario pilot project studied the related question of whether providing patients with education on kidney transplant options increases their likelihood of pursuing KT and LDKT.
Our preliminary results suggest that providing focused KT education does indeed increase patients’ transplant knowledge and also their confidence in being able to overcome challenges they may encounter as they pursue KT. In addition, we are engaging with African, Chinese, Muslim and South Asian Canadian communities and their leaders in order to improve our understanding of their culture-specific barriers and concerns, so that we can develop culturally and religiously competent KT education guides for these communities in the main languages they speak.
Link to paper: https://www.ncbi.nlm.nih.gov/pubmed/28207634
Ethnic Background Is a Potential Barrier to Living Donor Kidney Transplantation in Canada: A Single-Center Retrospective Cohort Study.
Istvan Mucsi, Aarushi Bansal, Olusegun Famure, Yanhong Li, Margot Mitchell, Amy D. Waterman, Marta Novak, and S. Joseph Kim