Differences in Acceptance to the Kidney Transplant List

ABSTRACT

Purpose: During the COVID-19 pandemic, kidney transplant (KT) evaluations shifted from in-person evaluation (IPE) to telemedicine evaluation (TME). Given differences in access to electronics and internet, we thought that TME may advantage some social groups' access to the KT list. We evaluated if differences in acceptance to KT listing exist between pre- and post-pandemic eras, or between IPE and TME. We identified associations between other socioeconomic factors and KT listing. Method(s) Demographic and social data were collected from charts of patients evaluated for KT in the pre- (3/13/2019-3/13/2020) and post-pandemic era (3/14/2020- 3/14/2021). Categorical data are presented in proportions and frequencies;continuous data in means+/-SDEV. Independent group t-tests and Fisher's exact tests were used for bivariate comparisons. Result(s) Of 1061 charts, 1015 included data on race/ethnicity 608 (59.1%) Black, 335 (33.6%) White, 40 (3.9%) Hispanic, 29 (2.8%) Asian, and 3 (0.3%) other. Overall, 629 (59%) evaluations were pre- and 430 (41%) post-pandemic. 734 (72%) were IPE and 288 (28%) TME. 553 (54%) candidates were denied for medical (310, 56%) and social (184, 33%) reasons;469 (46%) were accepted for listing. Employment status was known in 979 candidates 278 (28%) employed, 368 (38%) disabled, 66 (7%) unemployed, and 267 (27%) retired. Evaluation in the post-pandemic era (p=0.002) was associated with acceptance for listing. TME was also associated with acceptance for listing (p<0.001). Pre-pandemic, there were 604 IPE and 1 TME of whom 253 (42%) were accepted, including the TME (p=0.238). Post-pandemic 130 evaluations were IPE and 287 TME, of whom 215 (52%) were accepted, including 58 (45%) IPE and 157 (55%) TME (p=0.061). Employment status (p<0.001) and mental health status (p=0.009) were associated with acceptance for listing. There was no association between race/ethnicity (p=0.809) or distance from home to the transplant center (p=0.693) and acceptance for listing. There were no differences in race/ ethnicity (p=0.951), employment status (p=0.202), or mental health status (p=0.742) between pre- and post-pandemic eras. Assessment of social support (p=0.002) and overall social work assessment (p<0.001) were associated with acceptance for listing. The level of social support (rated on a 1-5 scale) was associated with being accepted for listing pre-pandemic (p=0.001) but not post-pandemic (p=0.769). Conclusion(s) KT evaluations decreased by about one third during the post-pandemic era. Evaluation in the post-pandemic era, evaluation by TME, employment status, mental health status, assessment of social support and overall social work assessment were all associated with being listed for KT. There were no differences in race/ethnicity, employment status, or mental health status between eras, which is unexpected given the additional stressors of the pandemic on employment and mental health.