General Surgery Resident Cozette Killian, M.D., and Arnold G. Diethelm Endowed Chair in Transplantation Surgery and Director of the UAB Comprehensive Transplant Institute Jayme Locke, M.D., MPH, published “Evaluation of Community-Level Vulnerability and Racial Disparities in Living Donor Kidney Transplant” in the journal JAMA Surgery alongside members of the Transplant Epidemiology and Analytics in Medicine (TEAM) lab.

Understanding that racial disparities in living donor kidney transplantation (LDKT) – the best treatment for end stage kidney disease – have increased the last two decades and are not explained by patient-level differences, the authors sought to evaluate racial disparities while accounting for the community environments in which patients live. The national study retrospectively examined 19,287 adult transplant recipients who underwent either deceased donor kidney transplantation (DDKT) or LDKT in 2018.

While living in more vulnerable communities decreased access to LDKT, community vulnerability did not explain racial disparities. Kidney recipients from racial minority groups were less likely to receive LDKT compared to White counterparts even after accounting for community-level vulnerability and patient-level characteristics.

Authors also found that the disparity in LDKT between African American/Black (AAB) and White recipients increased with greater community vulnerability. In the most vulnerable communities, AAB recipients were 48 percent less likely to receive LDKT, and even in the least vulnerable areas, such as Beverly Hills, California, AAB recipients were 24 percent less likely to receive LDKT compared to white recipients.

“Social determinants of health must be addressed to improve access to LDKT, but these data suggest that addressing this alone will not eliminate racial disparities in LDKT,” said Killian. “We need to be cognizant of the possible ways in which the health care system contributes to these disparities.”

Corresponding and senior author, Jayme Locke, M.D., MPH, believes implicit biases among transplant providers should be examined as a possible explanation of the authors’ findings. “Implicit racial biases, exacerbated by poverty biases, may be impacting physician decision-making during living kidney donor evaluations,” said Locke. ”Given the 95 percent racial concordance between LDKT recipients and their donors, these decisions may be inadvertently perpetuating racial disparities in LDKT.”

Other study authors included:

• Brittany Shelton, MPH
• Paul MacLennan, Ph.D.
• M. Chandler McLeod, Ph.D.
• Alexis Carter, MPH
• Rhiannon Reed, DrPH, MPH
• Haiyan Qu, Ph.D., MSHA
• Babak Orandi, M.D., Ph.D.
• Vineeta Kumar, M.D.
• Brittany Shelton, MPH

To read the entire study and its methods, click here. To listen to the JAMA Surgery Author Interview podcast episode, click here.