Equity in access to kidney transplants by race/ethnicity in the COVID-19 era

ABSTRACT

Purpose: The direct impact of the COVID-19 pandemic on minority populations has been well documented, and it is conceivable that disparities in access to kidney transplants by race and ethnicity have been exacerbated during the pandemic. Barriers to transplant may have emerged due to concerns about increased susceptibility to COVID-19 among racial/ethnic minorities. Methods: We examined quarterly trends in deceased donor kidney transplants per patient-year on the waiting list over time (1/2017-9/2020) among 4 major racial/ ethnic groups (White;Black;Hispanic;Asian). Unadjusted and adjusted Poisson regressions were used to estimate transplant rates pre-COVID-19 (1/2019-3/2020) and during COVID-19 (4/2020-9/2020). In addition to race/ethnicity, adjusted models included 17 factors such as blood type, CPRA, age, gender, diagnosis, and transplant center. Median KDPI was calculated among recipients. Results: For all 4 racial/ethnic groups, transplant rates rose steadily prior to COVID- 19, declined initially during the pandemic, and rebounded sharply in Jul-Sep '20. However, the decline was sharpest for Hispanic candidates, and the COVID-19-era rebound was greatest for White and Asian candidates (Fig 1). Relative to Whites, the transplant incidence rate ratio (IRR) declined in the COVID- 19 era for minorities (race by era interaction, p=0.0006, Fig 2a). Racial/ethnic transplant rate differences, and the race by era interaction, were both substantially attenuated in risk-adjusted modeling (Fig 2b). Median KDPI remained unchanged or improved during the pandemic for both White and minority recipients. Conclusions: Remarkably, the overall transplant rate surpassed pre-pandemic levels, as the transplant community has adapted remarkably well to the pandemic. But early COVID-19-era data suggest racial/ethnic disparities may have increased, particularly for Hispanic candidates. As the community continues to adapt and plan for the possibility of further pandemic impact, practices to ensure safe and equitable access to transplantation for vulnerable groups should be further developed and disseminated. (Table Presented).