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    Impact of the new kidney allocation system A2/A2B --> B policy on access to transplantation among minority candidates

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    Authors
    Martins, Paulo N.A.
    Mustian, Margaux N.
    MacLennan, Paul A.
    Ortiz, Jorge A.
    Akoad, Mohamed
    Caicedo, Juan Carlos
    Echeverri, Gabriel J.
    Gray, Stephen H.
    Lopez-Soler, Reynold I.
    Gunasekaran, Ganesh
    Kelly, Beau
    Mobley, Constance M.
    Black, Sylvester M.
    Esquivel, Carlos
    Locke, Jayme E.
    Show allShow less
    UMass Chan Affiliations
    Department of Surgery, Transplant and Hepatobiliary Surgery Division, UMass Memorial Medical Center
    Document Type
    Journal Article
    Publication Date
    2018-08-01
    Keywords
    disparities
    ethics and public policy
    ethnicity/race
    health services and outcomes research
    kidney transplantation/nephrology
    organ procurement and allocation
    Analytical, Diagnostic and Therapeutic Techniques and Equipment
    Bioethics and Medical Ethics
    Health Policy
    Health Services Administration
    Health Services Research
    Nephrology
    Race and Ethnicity
    Surgery
    Show allShow less
    
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    Link to Full Text
    https://doi.org/10.1111/ajt.14719
    Abstract
    Blood group B candidates, many of whom represent ethnic minorities, have historically had diminished access to deceased donor kidney transplantation (DDKT). The new national kidney allocation system (KAS) preferentially allocates blood group A2/A2B deceased donor kidneys to B recipients to address this ethnic and blood group disparity. No study has yet examined the impact of KAS on A2 incompatible (A2i) DDKT for blood group B recipients overall or among minorities. A case-control study of adult blood group B DDKT recipients from 2013 to 2017 was performed, as reported to the Scientific Registry of Transplant Recipients. Cases were defined as recipients of A2/A2B kidneys, whereas controls were all remaining recipients of non-A2/A2B kidneys. A2i DDKT trends were compared from the pre-KAS (1/1/2013-12/3/2014) to the post-KAS period (12/4/2014-2/28/2017) using multivariable logistic regression. Post-KAS, there was a 4.9-fold increase in the likelihood of A2i DDKT, compared to the pre-KAS period (odds ratio [OR] 4.92, 95% confidence interval [CI] 3.67-6.60). However, compared to whites, there was no difference in the likelihood of A2i DDKT among minorities post-KAS. Although KAS resulted in increasing A2/A2B-->B DDKT, the likelihood of A2i DDKT among minorities, relative to whites, was not improved. Further discussion regarding A2/A2B-->B policy revisions aiming to improve DDKT access for minorities is warranted.
    Source

    Am J Transplant. 2018 Aug;18(8):1947-1953. doi: 10.1111/ajt.14719. Epub 2018 Mar 31. Link to article on publisher's site

    DOI
    10.1111/ajt.14719
    Permanent Link to this Item
    http://hdl.handle.net/20.500.14038/49747
    PubMed ID
    29509285
    Related Resources

    Link to Article in PubMed

    ae974a485f413a2113503eed53cd6c53
    10.1111/ajt.14719
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