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Factors Underlying Racial Disparity in Utilization of Hepatitis C-Viremic Kidneys in the United States

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Abstract

Utilization of hepatitis C (HCV) viremic kidneys is increasing in the United States. We examined racial disparity in this utilization using UNOS/OPTN data (2014–2020) and mixed effects models adjusting for donor/recipient/center factors. Included in the study were 58,786 adults receiving a deceased donor kidney transplant from 191 centers. Two thousand six hundred thirteen (4%) received kidneys from HCV-viremic donors. Of these, 1598 (61%) were HCV seronegative and 1015 (49%) were HCV seropositive. Among seronegative recipients, before adjusting for waiting time and education, Blacks (OR 0.69, 95%CI (0.60, 0.80)), Hispanics (OR 0.63, 95%CI (0.51, 0.79)), and Asians (OR 0.69, 95%CI (0.53, 0.90)) were less likely than Whites to receive HCV-viremic kidneys. In final models, effect of race was attenuated. Notably, shorter waiting time (OR 0.65, 95%CI (0.63, 0.67)) and increasing educational level (grade school less likely compared to high school OR 0.67, 95% CI (0.49, 0.92) and college more likely than high school (OR 1.16 95% CI (1.02, 1.31)) were associated with receipt of HCV-viremic kidneys. Among HCV-seropositive recipients, recipient race was not independently associated with receipt of HCV-viremic kidneys; however, centers with larger populations of Black waitlisted patients were more likely to utilize HCV-viremic kidneys (OR 1.71, 95%CI (1.20, 2.45)) compared to other centers. Our results suggest recipient race does not independently determine who receives HCV-viremic kidneys; however, other underlying factors including waiting time, education (among seronegative), and center racial mix (among seropositive) contribute to the current differential distribution of HCV-viremic kidneys among races.

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Data Availability

The data is freely available from the OPTN/UNOS.

Code Availability

The authors will make the code available upon request.

Abbreviations

ANOVA:

Analysis of variance

cPRA:

Calculated panel reactive antibodies

D:

Donor positive

DCD:

Donation after cardiac death

EXPANDER:

Exploring transplants using hepatitis C-infected kidneys for HCV-negative recipients

GN:

Glomerulonephritis

HCV:

Hepatitis C

HIV:

Human immunodeficiency virus

HLA:

Human leukocyte antigen

HTN:

Hypertension

IQR:

Interquartile range

KAS:

Kidney allocation score

KDPI:

Kidney donor profile index

KDRI:

Kidney donor risk index

OPTN:

Organ procurement and transplant network

PHS:

Public health service

R:

Recipient positive

R:

Recipient negative

STAR:

Standard transplant analysis file

THINKER:

Transplanting Hepatitis C Kidneys into Negative Kidney Recipients

US:

United States

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Funding

This study was supported by NIH grant T32DK077662 PI MM ABECASSIS MD.

Author information

Authors and Affiliations

  1. Division of Transplant Surgery, Weill Cornell Medical Center, 525 East 68 thStreet, Box 98, New York, NY, 10065, USA

    Kofi Atiemo

  2. Comprehensive Transplant Center (CTC), Feinberg School of Medicine, Northwestern University Transplant Research Collaborative (NUTORC), Northwestern University, Chicago, IL, USA

    Rebecca Craig-Schapiro, Kexin Guo, Nikhilesh Mazumder, Lihui Zhao & Daniela Ladner

  3. Department of Preventive Medicine, Feinberg School of Medicine, Northwestern Medicine, Chicago, IL, USA

    Lihui Zhao

  4. Division of Transplantation, Department of Surgery, Northwestern Medicine, Chicago, IL, USA

    Daniela Ladner

  5. Center for Healthcare Studies, Institute for Public Health and Medicine, Northwestern Medicine, Chicago, IL, USA

    Daniela Ladner

  6. Epidemiology Department, Tulane School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA

    Robin Baudier & Amanda Anderson

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Contributions

Research idea and study design: KA; data analysis/interpretation: KA, RB, RCS, KG, NM, LZ; statistical analysis: KA, RB, KG, LZ; supervision, writing review and editing KA, RB, RCS, DL, LZ, AA. (LZ and DP contributed equally to this article).

Corresponding author

Correspondence to Kofi Atiemo.

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Ethics Approval

The study was approved by the Tulane University Institutional Review Board.

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Not applicable (retrospective analysis of de-identified data).

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Not applicable (retrospective analysis of de-identified data).

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The authors declare no competing interests.

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Atiemo, K., Baudier, R., Craig-Schapiro, R. et al. Factors Underlying Racial Disparity in Utilization of Hepatitis C-Viremic Kidneys in the United States. J. Racial and Ethnic Health Disparities 10, 2185–2194 (2023). https://doi.org/10.1007/s40615-022-01398-0

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