||Lui, E., Xu, X., Shah, V., Gill, J., Ahmadzadeh, G., Raissi, A., Waterman, A., Novak, M., Mucsi, I.
||Background: To assess how immigration status affects attitudes about and pursuit of living donor kidney transplant (LDKT) .
Methods: A cross-sectional sample of adults on dialysis from dialysis units in Toronto completed standard, validated questionnaires asking about readiness to explore LDKT, kidney transplant (KT) knowledge and factors influencing their decision about KT. The primary exposure was immigrant status (immigrant vs. non-immigrant). The primary outcome was whether at least one potential living donor was identified. The secondary outcome was readiness to pursue LDKT: late (“taking actions”) vs early (“considering/not considering” LDKT).
Results: Out of 544 participants, 5% were recent immigrants (≤ 9 years), 7% were medium-term immigrants (9-20 years), 51% were long term immigrants (≥ 20 years). Immigrants were older (60 vs 23 years, p<0.001), were more likely to earn <$30,000/year (67% vs 34%) and to have had <12 years of education (64% vs 36%, p=0.009). The proportion of non-white ethnicity was 77% among immigrants vs 27% among non-immigrants (p<0.001).
Immigrant vs non-immigrant patients were less likely to have at least a potential living donor identified (OR [95% CI] 0.392 [0.253-0.609], p<0.001) after adjusting for age, sex, marital status, income, education, comorbidity and dialysis vintage. This association remained significant after adjusting for ethnicity (0.582 [0.351-0.964], p=0.036). Similarly, immigrant patients were less likely to be in late stages of LDKT readiness, but the association has become non-significant in the multivariable adjusted model (0.821 [0.480-1.405], p=0.478).
Conclusion: Compared to non-immigrant patients, immigrant patients are less likely to be taking LDKT actions or having potential living donors identified. Like socioeconomic status and ethnic/racial background, immigration status may be another area of disparity in access to LDKT.
Keywords: Kidney, Living Donor Kidney Transplantation, Psychosocial, Immigration