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. 2021 Dec 23;15(5):942-950.
doi: 10.1093/ckj/sfab287. eCollection 2022 May.

The effect of race coefficients on preemptive listing for kidney transplantation

Mersema Abate  1 , Nicholas Jandovitz  2 , Jamie S Hirsch  1 , Nadine Breslin  3 , Lawrence Lau  2 , Ahmed E Fahmy  2 , Kenar D Jhaveri  1 , Safiya Richardson  4 , Yaser Alsalmay  5 , Anthony Baez  6 , Akash Mishra  7 , Siavash Bolourani  2 , Santiago J Miyara  7 , Aaron Winnick  2 , Gayatri Nair  1 , Madhu C Bhaskaran  1 , Elliot Grodstein  2 , Adam M Kressel  6 , Lewis W Teperman  2 , Ernesto P Molmenti  1 , Vinay Nair  1
Affiliations

The effect of race coefficients on preemptive listing for kidney transplantation

Mersema Abate et al. Clin Kidney J. .

Abstract

Background: Race coefficients of estimated glomerular filtration rate (eGFR) formulas may be partially responsible for racial inequality in preemptive listing for kidney transplantation.

Methods: We used the Scientific Registry of Transplant Recipients database to evaluate differences in racial distribution of preemptive listing before and after application of the Modification of Diet in Renal Disease (MDRD) and the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) race coefficients to all preemptively listed non-Black kidney transplant candidates (eGFR modulation). Odds of preemptive listing were calculated by race, with Black as the reference before and after eGFR modulation. Variables known to influence preemptive listing were included in the model.

Results: Among 385 087 kidney-alone transplant candidates from 1 January 2010 to 2 December 2020, 118 329 (30.7%) candidates were identified as preemptively listed (71.7% White, 19% Black, 7.8% Asian, 0.6% multi-racial, 0.6% Native American and 0.3% Pacific Islander). After eGFR modulation, non-Black patients with an eGFR ≥20 mL/min/1.73 m2 were removed. Compared with Black candidates, the adjusted odds of preemptive listing for White candidates decreased from 2.01 [95% confidence interval (95% CI) 1.78-2.26] before eGFR modulation to 1.18 (95% CI 1.0-1.39; P = 0.046) with the MDRD and 1.37 (95% CI 1.18-1.58) with the CKD-EPI equations after adjusting for race coefficients.

Conclusions: Removing race coefficients in GFR estimation formulas may result in a more equitable distribution of Black candidates listed earlier on a preemptive basis.

Keywords: CKD-EPI equation; GFR; MDRD; ethnicity; kidney transplantation.

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Figures

Graphical Abstract
Graphical Abstract
FIGURE 1:
FIGURE 1:
Study population.
FIGURE 2:
FIGURE 2:
(A) Number of non-Black versus Black candidates listed for kidney transplantation by UNOS region from 2010 to 2020. (B) Percentage of non-Black versus Black patients preemptively listed for kidney transplantation by UNOS region from 2010 to 2020. (C) Map of UNOS regions obtained from the US Organ Procurement and Transplant Network. https://optn.transplant.hrsa.gov/about/regions/.
See this image and copyright information in PMC

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