ArticlePloS one2018
Transplant center assessment of the inequity in the kidney transplant process and outcomes for the Indigenous American patients.
Article in PloS one, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers, 2 of them syntheses that pooled it.
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
11 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Pooled it
- Postoperative outcomes for Indigenous Peoples in Canada: a systematic review.CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2021Pooled it
- Clinician Perspectives on Barriers and Facilitators to Abdominal Organ Transplant Access.JAMA network open · 2026Article
- Addressing Unmet Needs in the Management of Chronic Kidney Disease.International journal of general medicine · 2026Review
- A Single-Center Report of Hypertension in Native American Kidney Transplant Recipients.Journal of immigrant and minority health · 2025Observational
- Experiential Evidence of Systemic Racism for Indigenous Peoples Navigating Transplantation in Canada.Kidney international reports · 2025Article
- The Value of Pharmacogenomics for White and Indigenous Americans after Kidney Transplantation.Pharmacy (Basel, Switzerland) · 2023Article
- Protocol for the AKT-MP trial: Access to Kidney Transplantation in Minority Populations.Contemporary clinical trials communications · 2022Article
- Non-medical barriers in access to early steps of kidney transplantation in the United States - A scoping review.Transplantation reviews (Orlando, Fla.) · 2021Article
- Patient and allograft outcomes after kidney transplant for the Indigenous patients in the United States.PloS one · 2021Article
- Modest rates and wide variation in timely access to repeat kidney transplantation in the United States.American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons · 2020Article
Corrections and comments
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Authors and funding
7 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThe goal is to determine the delays and reduced rates of kidney transplant (KTx) for the Indigenous Americans and variables predictive of these outcomes at a large single transplant center.
methods300 Indigenous Americans and 300 non-Hispanic white American patients presenting for KTx evaluation from 2012-2016 were studied.
resultsCompared to whites, the Indigenous Americans had the following: more diabetes, dialysis, physical limitation and worse socioeconomic characteristics(p<0.01); median difference of 20 day delay from referral to KTx evaluation, 17 day delay from approval to UNOS listing and 126.5 longer delay on the waitlist compared to whites(p<0.001). Of the Indigenous Americans listed, more died, were removed, or were still waiting than transplanted compared to whites (p<0.001). Variables predictive of delay from referral to transplant evaluation included: Indigenous race, distance from transplant center, coronary artery disease, and time on dialysis (p<0.05). Cumulative incidence of waitlisting and KTx was lower for Indigenous Americans (p<0.0001). Independent predictors of decreased likelihood of waitlisting included age, peripheral vascular disease, no caregiver, physical limitation, and illegal drug use history (p<0.05). Variables predictive of lower likelihood of KTx included Indigenous race, percentage of time inactive on the waitlist, no caregiver, and O blood type.
conclusionsAmong patients referred and evaluated for KTx, the Indigenous American race was independently associated with significant delays in the KTx process after accounting for co-morbid and socioeconomic factors. Cardiovascular morbidity and physical limitation were identified as important determinants of delay and decreased likelihood of waitlisting. Further quantitative and qualitative work is needed to identify and intervene on modifiable barriers to improve access to KTx for the Indigenous Americans.
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