• David J Taber, Zemin Su, Mulugeta Gebregziabher, Patrick D Mauldin, Thomas A Morinelli, Ammar O Mahmood, Gayenell S Magwood, Michael J Casey, Joseph R Scalea, Sam M Kavarana, Prabhakar K Baliga, James R Rodrigue, and Derek A DuBay.
• From the Medical University of South Carolina, Division of Transplant Surgery (Taber, Morinelli, Mahmood, Scalea, Kavarana, Baliga, DuBay), Charleston, SC.
• J. Am. Coll. Surg. 2023 Apr 1; 236 (4): 721727721-727.

BackgroundAfrican Americans (AAs) have reduced access to kidney transplant (KTX). Our center undertook a multilevel quality improvement endeavor to address KTX access barriers, focused on vulnerable populations. This program included dialysis center patient/staff education, embedding telehealth services across South Carolina, partnering with community providers to facilitate testing/procedures, and increased use of high-risk donors.Study DesignThis was a time series analysis from 2017 to 2021 using autoregression to assess trends in equitable access to KTX for AAs. Equity was measured using a modified version of the Kidney Transplant Equity Index (KTEI), defined as the proportion of AAs in South Carolina with end-stage kidney disease (ESKD) vs the proportion of AAs initiating evaluation, completing evaluation, waitlisting, and undergoing KTX. A KTEI of 1.00 is considered complete equity; a KTEI of <1.00 is indicative of disparity.ResultsFrom January 2017 to September 2021, 11,487 ESKD patients (64.7% AA) were referred, 6,748 initiated an evaluation (62.8% AA), 4,109 completed evaluation (59.7% AA), 2,762 were waitlisted (60.0% AA), and 1,229 underwent KTX (55.3% AA). The KTEI for KTX demonstrated significant improvements in equity. The KTEI for initiated evaluations was 0.89 in 2017, improving to 1.00 in 2021 (p = 0.0045). Completed evaluation KTEI improved from 0.85 to 0.95 (p = 0.0230), while waitlist addition KTEI improved from 0.83 to 0.96 (p = 0.0072). The KTEI for KTX also improved from 0.76 to 0.91, which did not reach statistical significance (p = 0.0657).ConclusionsA multilevel intervention focused on improving access to vulnerable populations was significantly associated with reduced disparities for AAs.Copyright © 2023 by the American College of Surgeons. Published by Wolters Kluwer Health, Inc. All rights reserved.

15 keywords...

hide…