MedicalResearch.com Interview with:
Sanjay Kulkarni, MD MHCM FACS
Associate Professor of Surgery & Medicine
Surgical Director – Kidney Transplant Program
Medical Director – Center for Living Organ Donors
Scientific Director – Yale Transplant Research
New Haven, CT 06410
MedicalResearch.com: What is the background for this study?
Response: The kidney allocation system changed in December of 2014.
The aim of the new system was to increase transplant in patients who were highly sensitized (difficult matches based on reactive antibodies) and to improve access to underserved populations.
MedicalResearch.com: What are the main findings?
Response: We found that health disparities continue after listing for transplant. It is important to recognize that when a patient is placed on the waitlist, he or she has a 5-7 year wait for a deceased donor transplant. What happens in those years? We were able to show that health disparities continue during this time, which decreases access to transplant.
Patients who have a medical issue and are not ready for transplant are made inactive on the waitlist, which means they are temporarily not eligible until issues are resolved. We were able to show that patients from minority groups had a statistically worse probability of becoming active after an inactive status change versus whites.
MedicalResearch.com: What should readers take away from your report?
Response: There needs to be better care coordination between transplant centers and dialysis units on shared listed patients. Currently, each practice within their own health network. By focusing on the problem of inactive patients, better health care delivery can improve outcomes and address these health disparities.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: We suggest that an inactive to active metric be used in incentive compensation models for both dialysis units and transplant centers. This will be the first metric that is shared between these health entities and effectively incentivize care coordination.
Any disclosures? The study was funded by an unrestricted grant from Alexion Pharmaceuticals.
Kulkarni S, Ladin K, Haakinson D, Greene E, Li L, Deng Y. Association of Racial Disparities With Access to Kidney Transplant After the Implementation of the New Kidney Allocation System. JAMA Surg. Published online April 03, 2019. doi:10.1001/jamasurg.2019.0512
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