Thongprayoon Charat, Garcia Valencia Oscar A, Jadlowiec Caroline C, Mao Shennen A, Mao Michael A, Leeaphorn Napat, Pham Justin H, Csongradi Eva, Craici Iasmina M, Budhiraja Pooja, Cheungpasitporn Wisit
Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, USA.
Division of Transplant Surgery, Mayo Clinic, Phoenix, AZ, USA.
Sci Rep. 2025 Feb 10;15(1):4879. doi: 10.1038/s41598-025-88672-3.
Disparities in access to care and transplantation outcomes, including prolonged waitlist times and reduced living donor transplantation rates, are well-documented in Hispanic kidney transplant patients. While post-transplant graft and patient survival rates are generally comparable to those of non-Hispanic white patients, variability within the Hispanic population is driven by socioeconomic and clinical factors. Insurance type may be a crucial determinant of both access to transplantation and post-transplantation outcomes, warranting a focused study of its impact within this population. We used the OPTN/UNOS database to identify Hispanic kidney-only transplant recipients in the United States between 2015 and 2019. We categorized patients by insurance type to public versus non-public insurance. We compared risk of graft failure and death after kidney transplant between the public and non-public insurance groups. Of 14,639 Hispanic kidney transplant recipients, 10,761 (74%) had public insurance. Public insurance group were older, had more kidney retransplant, more deceased donor but less preemptive kidney transplant, longer dialysis duration, more diabetes, peripheral vascular disease, reduced functional status, and were less likely to be employed or have high education level compared to non-public insurance group. Public insurance was significantly associated with an increased risk of death-censored graft failure (HR 1.36; 95% CI 1.16-1.60) and patient death (HR 1.15; 95% CI 1.01-1.30). Similarly, public insurance was significantly associated with an increased risk of graft failure when accounting for death as the competing risk. Disparities in post-transplant outcomes were observed between Hispanic kidney recipients with public versus non-public insurance. Public insurance was a significant predictor for reduced graft and patient survival after kidney transplant.
在西班牙裔肾移植患者中，获得医疗服务和移植结果的差异有充分记录，包括等待名单时间延长和活体供体移植率降低。虽然移植后移植物和患者生存率通常与非西班牙裔白人患者相当，但西班牙裔人群内部的差异是由社会经济和临床因素驱动的。保险类型可能是获得移植和移植后结果的关键决定因素，因此有必要对其在该人群中的影响进行重点研究。我们使用器官获取与移植网络（OPTN）/美国器官共享联合网络（UNOS）数据库，确定2015年至2019年期间在美国仅接受肾移植的西班牙裔受者。我们根据保险类型将患者分为公共保险和非公共保险两类。我们比较了公共保险组和非公共保险组肾移植后移植物失败和死亡的风险。在14639名西班牙裔肾移植受者中，10761名（74%）拥有公共保险。与非公共保险组相比，公共保险组年龄更大，再次肾移植更多， deceased donor更多但抢先肾移植更少，透析时间更长，糖尿病、外周血管疾病更多，功能状态降低，就业或受教育程度高的可能性更小。公共保险与死亡审查的移植物失败风险增加（风险比1.36；95%置信区间1.16 - 1.60）和患者死亡风险增加（风险比1.15；95%置信区间1.01 - 1.30）显著相关。同样，当将死亡作为竞争风险考虑时，公共保险与移植物失败风险增加显著相关。在拥有公共保险和非公共保险的西班牙裔肾移植受者之间观察到移植后结果的差异。公共保险是肾移植后移植物和患者生存率降低的重要预测因素。
