Healthcare-Related Sociocultural Factors, Racial Disparities, and Kidney Transplant Outcomes in the Kidney Transplant Fast Track Program.

BACKGROUND

In the United States, streamlining the kidney transplantation (KT) evaluation process may reduce disparities and barriers to KT access. Prior work showed that the Kidney Transplant Fast Track (KTFT) program shortened this process and reduced racial disparities in waitlisting and overall KT. In the present study, we examined whether race/ethnicity and sociocultural factors (e.g., medical mistrust, healthcare-related discrimination/racism) remained independently associated with time to active waitlisting and KT receipt (overall, living [LDKT] and deceased donor KT [DDKT]) and whether sociocultural factors attenuated racial/ethnic differences in these outcomes.

METHODS

In this secondary analysis, data came from the KTFT study, a prospective KT candidate cohort. Participants were recruited before KT evaluation start (05/2015-06/2018), coinciding with baseline measure collection, then followed via medical record through 08/2022. We used hierarchically-adjusted Fine-Gray proportional hazards models in this exploratory analysis.

RESULTS

Among 1108 KT candidates (243 Black, 783 White, 82 Other), medical mistrust was associated with lower cumulative incidence of waitlisting, but no other sociocultural factors were associated with outcomes. Racial and ethnic differences emerged for KT type: Black participants had a greater cumulative incidence of DDKT, and participants categorized as other race/ethnicity had a lower cumulative incidence of LDKT, relative to White participants.

CONCLUSIONS

Although KTFT reduced racial/ethnic disparities in waitlisting and overall KT receipt, we identified racial/ethnic differences in LDKT and DDKT. Medical mistrust was a significant barrier to waitlisting. Findings suggest that even when the KT evaluation process is streamlined, sociocultural factors and race/ethnicity may remain associated with KT outcomes.

TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT02342119.