Clinical journal of the American Society of Nephrology : CJASN · 2026
Disparities in Kidney Transplantation Access and Outcomes among Native Hawaiians and Pacific Islanders in the United States.
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Noguchi Kiyonari, Wong Linda L, Izutsu Christie H, Rhee Connie M, Lee Lung-Yi Felix
Аннотация
KEY POINTS: Native Hawaiian and Pacific Islander kidney transplant candidates were geographically concentrated in Organ Procurement and Transplantation Network regions 5 and 6. Native Hawaiian and Pacific Islander kidney candidates were more likely to be inactive on the waitlist with longer wait time to transplant. Once transplanted, Native Hawaiian and Pacific Islander recipients had similar long-term posttransplant outcomes as White recipients.
BACKGROUND: Native Hawaiian and Pacific Islander (NHPI) individuals are an underrepresented population with a disproportionate burden of ESKD. Many NHPI individuals are of multiple races, yet studies frequently aggregate them into other racial and ethnic groups, masking important differences in outcomes.
METHODS: We conducted a retrospective cohort study of all adult, kidney-only, waitlisted candidates in the Organ Procurement and Transplantation Network dataset (December 2014 to December 2022) comparing NHPI individuals, including multiracial individuals with NHPI ancestry, with White and other racial and ethnic groups on their waitlist and transplant outcomes. Waiting time to transplantation was assessed using competing risk analyses, accounting for waitlist removal. Death-censored graft survival and transplant survival were assessed using the Kaplan-Meier method and Cox proportional hazards model.
RESULTS: Among 313,033 candidates, 1800 were of NHPI ancestry (1521 single race, 279 multiracial). NHPI candidates were younger, had higher body mass index, and were more likely to have diabetes. Most were listed in Organ Procurement and Transplantation Network regions 5 (50%) and 6 (25%). Compared with White and other racial and ethnic groups, NHPI candidates were more likely to be inactive on the waitlist (NHPI candidates: 19% versus White candidates: 12%; P < 0.001). Taking into account the competing risk of waitlist removal, NHPI had longer waiting time to transplant (estimated time to transplant 50% of the waitlisted NHPI candidates: 9.9 [8.5-12.3] years versus waitlisted White candidates: 5.7 [5.7-5.8] years; P < 0.001), and one the lowest rates of being transplanted (cause-specific hazard ratio, 0.60 [0.55 to 0.65]; P < 0.001 in reference to White candidates). Once transplanted, NHPI recipients had similar graft and patient survival compared with White recipients.
CONCLUSIONS: NHPI individuals demonstrated unique demographic and geographic characteristics associated with reduced transplant access but comparable posttransplant outcomes. Further work is needed to improve transplant access in this unique and underrepresented population.
BACKGROUND: Native Hawaiian and Pacific Islander (NHPI) individuals are an underrepresented population with a disproportionate burden of ESKD. Many NHPI individuals are of multiple races, yet studies frequently aggregate them into other racial and ethnic groups, masking important differences in outcomes.
METHODS: We conducted a retrospective cohort study of all adult, kidney-only, waitlisted candidates in the Organ Procurement and Transplantation Network dataset (December 2014 to December 2022) comparing NHPI individuals, including multiracial individuals with NHPI ancestry, with White and other racial and ethnic groups on their waitlist and transplant outcomes. Waiting time to transplantation was assessed using competing risk analyses, accounting for waitlist removal. Death-censored graft survival and transplant survival were assessed using the Kaplan-Meier method and Cox proportional hazards model.
RESULTS: Among 313,033 candidates, 1800 were of NHPI ancestry (1521 single race, 279 multiracial). NHPI candidates were younger, had higher body mass index, and were more likely to have diabetes. Most were listed in Organ Procurement and Transplantation Network regions 5 (50%) and 6 (25%). Compared with White and other racial and ethnic groups, NHPI candidates were more likely to be inactive on the waitlist (NHPI candidates: 19% versus White candidates: 12%; P < 0.001). Taking into account the competing risk of waitlist removal, NHPI had longer waiting time to transplant (estimated time to transplant 50% of the waitlisted NHPI candidates: 9.9 [8.5-12.3] years versus waitlisted White candidates: 5.7 [5.7-5.8] years; P < 0.001), and one the lowest rates of being transplanted (cause-specific hazard ratio, 0.60 [0.55 to 0.65]; P < 0.001 in reference to White candidates). Once transplanted, NHPI recipients had similar graft and patient survival compared with White recipients.
CONCLUSIONS: NHPI individuals demonstrated unique demographic and geographic characteristics associated with reduced transplant access but comparable posttransplant outcomes. Further work is needed to improve transplant access in this unique and underrepresented population.