Disparities in End-Organ Care for Hispanic Patients with Kidney and Liver Disease: Implications for Access to Transplantation

Appraisal of Impact of Race-Neutral Estimated Glomerular Filtration Rate Waiting Time Modification on Transplant Wait Time and Outcomes for Black Kidney Candidates: Importance of Transplant Readiness on the Waitlist

BACKGROUND

In July 2022, the Organ Procurement Transplant Network mandated race-neutral estimated glomerular filtration rate (eGFR) calculations when evaluating kidney transplantation (KT) candidates, replacing historic race-based estimates. This modification also required transplant programs to identify KT candidates on their waitlist who would have benefitted from an earlier waitlist qualification date using race-neutral calculations.

STUDY DESIGN

This retrospective study analyzed Black patients listed for KT at our center between 2000 and 2023, recalculating their eGFR using race-neutral formulas. KT recipients with modified wait times (N = 26) were compared with 2 control groups: Black recipients without modifications (N = 21) and non-Black recipients (N = 89). Postoperative outcomes, including complications and readmission rates, were analyzed across groups.

RESULTS

Of 126 Black patients evaluated, 60.3% qualified for wait time modifications, with a median gain of 570 days (1.6 years) per patient, totaling 62,057 days (180.7 years). Within 6 months of receiving additional time, 26 patients (34%) were transplanted, mostly from deceased donors (92%) with a median kidney donor profile index of 66%. Black KT recipients with modifications had significantly higher BMI, diabetes, and peripheral vascular disease compared with controls. Readmission rates were higher among Black KT recipients with modifications, although no significant differences in graft loss or mortality were observed.

CONCLUSIONS

Race-neutral eGFR recalculations substantially improved Black KT candidates' ability to receive a KT, addressing historical disparities in KT. However, higher comorbidities and readmissions among these patients suggest the need for thorough transplant readiness evaluations before waitlist activation.

Outcomes of SARS-CoV-2 Infection in Patients With Chronic Liver Disease and Cirrhosis: A National COVID Cohort Collaborative Study

BACKGROUND & AIMS

In patients with chronic liver disease (CLD) with or without cirrhosis, existing studies on the outcomes with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection have limited generalizability. We used the National COVID Cohort Collaborative (N3C), a harmonized electronic health record dataset of 6.4 million, to describe SARS-CoV-2 outcomes in patients with CLD and cirrhosis.

METHODS

We identified all patients with CLD with or without cirrhosis who had SARS-CoV-2 testing in the N3C Data Enclave as of July 1, 2021. We used survival analyses to associate SARS-CoV-2 infection, presence of cirrhosis, and clinical factors with the primary outcome of 30-day mortality.

RESULTS

We isolated 220,727 patients with CLD and SARS-CoV-2 test status: 128,864 (58%) were noncirrhosis/negative, 29,446 (13%) were noncirrhosis/positive, 53,476 (24%) were cirrhosis/negative, and 8941 (4%) were cirrhosis/positive patients. Thirty-day all-cause mortality rates were 3.9% in cirrhosis/negative and 8.9% in cirrhosis/positive patients. Compared to cirrhosis/negative patients, cirrhosis/positive patients had 2.38 times adjusted hazard of death at 30 days. Compared to noncirrhosis/positive patients, cirrhosis/positive patients had 3.31 times adjusted hazard of death at 30 days. In stratified analyses among patients with cirrhosis with increased age, obesity, and comorbid conditions (ie, diabetes, heart failure, and pulmonary disease), SARS-CoV-2 infection was associated with increased adjusted hazard of death.

CONCLUSIONS

In this study of approximately 221,000 nationally representative, diverse, and sex-balanced patients with CLD; we found SARS-CoV-2 infection in patients with cirrhosis was associated with 2.38 times mortality hazard, and the presence of cirrhosis among patients with CLD infected with SARS-CoV-2 was associated with 3.31 times mortality hazard. These results provide an additional impetus for increasing vaccination uptake and further research regarding immune responses to vaccines in patients with severe liver disease.