Article Figures & Data
Figures
- Figure 1.
Kidney transplant candidates included and excluded from study cohort.
- Figure 2.
Cumulative incidence probability by event status, with pointwise 95% confidence interval.
- Figure 3.
Cumulative incidence probability by event status separated by race (White and Black), with pointwise 95% confidence interval.
Tables
Variables Total Received a Transplanta Diedb Censoredc (n=1056) (n=363) (n=413) (n=280) Demographic characteristicsd Race/ethnicity Non-Hispanic White, n (%) 789 (75) 298 (82) 309 (75) 182 (65) Non-Hispanic Black, n (%) 267 (25) 65 (18) 104 (25) 98 (35) Sex (female), n (%) 406 (38) 141 (39) 146 (35) 119 (43) Age (in yr), mean (SD) 57±13 52±14 61±12 56±13 Education (≤high school), n (%) 496 (47) 147 (41) 212 (51) 137 (49) Household income (<US$50,000), n (%) 739 (74) 214 (62) 316 (81) 209 (79) Insurance status, n (%) Public only 277 (26) 148 (41) 62 (15) 67 (24) Private only 370 (35) 98 (27) 152 (37) 120 (43) Public and private 400 (38) 113 (31) 194 (48) 93 (33) Occupation (≥skilled manual worker), n (%) 512 (49) 190 (52) 201 (49) 121 (43) Marital status (not married), n (%) 512 (48) 171 (47) 195 (47) 146 (52) Final status after KAS, n (%)e 428 (41) 130 (36) 166 (40) 132 (47) Medical factors BMI, mean (SD) 29.6±6.3 29.3±6.2 29.6±6.3 29.9±6.3 Charlson Comorbidity Index, median (IQR) 4.0 (3.0–5.0) 4.0 (2.0–4.0) 5.0 (4.0–6.0) 4.0 (2.0–5.0) Type of dialysis, n (%) None 366 (35) 168 (46) 87 (21) 111 (39) Hemodialysis 583 (55) 158 (44) 277 (67) 148 (53) Peritoneal dialysis 107 (10) 37 (10) 49 (12) 21 (8) Dialysis duration in yr, median (IQR) 0.2 (0.0–0.7) 0.2 (0.0–0.7) 0.3 (0.1–0.9) 0.2 (0.0–0.7) Burden of kidney disease (range: 1–5), median (IQR) 4.0 (3.0–4.7) 3.7 (3.0–4.3) 4.0 (3.0–4.7) 3.7 (3.0–4.7) No. of potential donors, median (IQR) 17 (11–29) 20 (12–30) 15 (10–28) 18 (10–27) Have a potential living donor at T1 (yes), n (%) 556 (54) 225 (64) 183 (46) 148 (54) Cultural factors Experience of discrimination (any), n (%) 268 (26) 70 (19) 119 (29) 79 (28) Perceived racism (range: 1–5), median (IQR) 2.3 (2.0–2.8) 2.3 (2.0–2.5) 2.3 (2.0–2.8) 2.4 (2.0–2.8) Medical mistrust (range: 1–5), mean (SD) 2.4±0.5 2.4±0.5 2.5±0.5 2.5±0.5 Trust in physician (range: 1–5), mean (SD) 2.2±0.5 2.2±0.5 2.2±0.5 2.2±0.5 Family loyalty (range: 8–80), mean (SD) 49.8±9.4 49.5±9.6 49.6±9.2 50.7±9.5 Religious objection to living-donor kidney transplant, n (%) No objection 361 (35) 139 (39) 135 (34) 87 (31) Mixed (neutral + no objection) 100 (10) 32 (9) 50 (12) 18 (6) Any objection 580 (56) 189 (53) 218 (54) 173 (62) Overall religiosity (range: 1–9), median (IQR) 7.0 (4.5–9.0) 6.0 (4.0–8.5) 7.0 (5.0–9.0) 7.5 (5.0–9.0) Psychosocial characteristics Social support (range: 12–48), median (IQR) 44.0 (39.0–48.0) 45.0 (41.0–48.0) 44.0 (38.0–47.0) 43.0 (37.0–47.0) Self-esteem (range: 1–4), median (IQR) 3.1 (2.9–3.5) 3.1 (2.9–3.6) 3.0 (2.8–3.5) 3.1 (2.8–3.5) Mastery (range: 1–4), median (IQR) 3.0 (2.7–3.1) 3.0 (2.9–3.1) 2.9 (2.7–3.1) 3.0 (2.7–3.1) Internal locus of control (range: 1–6), mean (SD) 4.0±1.1 3.8±1.1 4.1±1.0 4.1±1.1 External locus of control (range: 1–6), mean (SD) 3.4±0.8 3.3±0.7 3.5±0.9 3.5±0.8 Anxiety (≥moderate), n (%) 47 (4) 13 (4) 21 (5) 13 (5) Depression (≥moderate), n (%) 42 (4) 11 (3) 20 (5) 11 (4) Transplant knowledge and education Transplant knowledge (range: 0–27), median (IQR) 22.0 (20–23.0) 23.0 (21.0–24.0) 21.0 (19.0–23.0) 21.0 (19.0–23.0) No. learning activities (range: 0–8), median (IQR) 5.0 (3.0–6.0) 5.0 (4.0–6.0) 4.0 (3.0–5.0) 4.0 (3.0–5.0) Total h of learning activities (range: 0–185), median (IQR) 10.3 (6.0–21.5) 12.0 (7.0–29.0) 10.0 (5.3–20.5) 9.5 (4.5–19.0) Transplant concerns (range: 0–30), mean (SD) 10.9±4.7 10.9±4.8 10.9±4.5 10.8±4.9 Donor preference, n (%) Deceased donor 135 (13) 46 (13) 50 (12) 39 (14) Living donor 815 (77) 287 (79) 313 (76) 215 (77) No preference 104 (10) 29 (8) 49 (12) 26 (9) Willing to accept living donor volunteer, n (%) 934 (90) 333 (93) 355 (88) 246 (90) Willing to ask for living donor donation, n (%) 582 (57) 205 (58) 222 (56) 155 (57) Years from evaluation to final follow-up, mean (range) 3.1 (0.003–8.5) 2.8 (0.07–7.7) 3.3 (0.06–8.2) 3.4 (0.003–8.5) KAS, Kidney Allocation System; IQR, interquartile range, i.e., the interval between the 25th and 75th percentiles; UPMC, University of Pittsburgh Medical Center; UNOS, United Network for Organ Sharing.
↵a Includes receiving a living-donor transplant at UPMC (n=109; White=100, Black=9), deceased-donor transplant at UPMC (n=218; White=167, Black=51), living-donor transplant at another center (n=15; White=14, Black=1), deceased-donor transplant at another center (n=14; White=12, Black=2), unknown transplant type at another center (n=7; White=5, Black=2). Unknown transplant type because UPMC does not have access to the UNOS data for other transplant centers, and participants could not be reached for verification, despite several attempts.
↵b Died before or after waitlist but before receiving a transplant.
↵c Censoring includes closed by patient choice (n=26–13 before waitlisting and 13 after waitlisting), clinic rejected (n=28), clinic removed patient from waiting list (n=56), transferred to another center (n=19), still in transplant evaluation (n=8), incomplete evaluation (n=114), or still on waitlist (n=29).
↵d n=1 missing for transplant concerns; n=2 missing for occupation, transplant knowledge, donor preference; n=4 missing for family loyalty score; n=5 missing in medical mistrust index, trust in physician; n=6 missing in total social support; n=7 missing for internal and external locus of control, experienced discrimination in health care; n=8 missing for self-esteem scale; n=9 missing for total h engaged in learning activities; n=9 missing for insurance type; n=11 missing for racism in health care; n=15 missing for religious objection to living-donor kidney transplant; n=19 for willing to accept living donor volunteer; n=31 for having living donor; n=32 for willing to ask for living donor donation; n=53 missing/unknown for income.
↵e Final status after KAS refers to whether the patient’s ultimate outcome (i.e., transplant, died, censored) occurred either before or after the KAS policy changes of 2014 to all of the tables that include this variable.
- Table 2.
Fine-Gray proportional subdistribution hazard model for time from evaluation to receiving any transplanta (n=997)b
Variables Model 1 Model 2 Model 3 Subdistribution Hazard Ratio 95% Confidence Interval Subdistribution Hazard Ratio 95% Confidence Interval Subdistribution Hazard Ratio 95% Confidence Interval Model 1 Race/ethnicity Non-Hispanic White 1 (ref) 1 (ref) 1 (ref) Non-Hispanic Black 0.60 0.46 to 0.78 0.67 0.51 to 0.90 0.74 0.55 to 0.99 Model 2 Demographic characteristics Age (in yr) 0.97 0.96 to 0.98 0.98 0.97 to 0.99 Household income (<US$50,000) 0.58 0.45 to 0.74 0.65 0.50 to 0.85 Insurance status Private only 1 (ref) 1 (ref) Public only 0.62 0.46 to 0.83 0.60 0.44 to 0.80 Public and private 0.75 0.57 to 0.99 0.67 0.52 to 0.88 Medical factors Charlson Comorbidity Index 0.82 0.76 to 0.89 0.85 0.78 to 0.91 Type of dialysis None 1 (ref) Hemodialysis 0.72 0.56 to 0.91 Peritoneal dialysis 0.74 0.50 to 1.10 Model 3 Final status after KASc 2.38 1.77 to 3.19 Cultural factors Overall religiosityd 0.96 0.91 to1.00 Psychosocial characteristics Social supportd 1.04 1.01 to 1.06 Transplant knowledge and education Transplant knowledged 1.06 1.00 to 1.11 No. learning activitiesd 1.08 1.01 to 1.16 Higher value, greater amount (or higher score) on a particular variable. KAS, Kidney Allocation System; SHR, subdistribution hazard ratio.
↵a Main event, received a transplant; competing event, died, censoring, still on waitlist or other removal.
↵b Sample size used for Models 1, 2, and 3: n=997 (i.e., those with complete data on all variables; 346 received a transplant, 385 died, 266 censored).
↵c Final status after KAS refers to whether the patient’s ultimate outcome (i.e., transplant, died, censored) occurred either before or after the KAS policy changes of 2014 to all of the tables that include this variable.
↵d The SHR for these variables are per one-point higher in each scale.
- Table 3.
Fine-Gray proportional subdistribution hazard model for time from evaluation to receiving a deceased-donor kidney transplanta (n=1036)b
Variables Model 1 Model 2 Model 3 Subdistribution Hazard Ratio 95% Confidence Interval Subdistribution Hazard Ratio 95% Confidence Interval Subdistribution Hazard Ratio 95% Confidence Interval Model 1 Race/ethnicity Non-Hispanic White 1 (ref) 1 (ref) 1 (ref) Non-Hispanic Black 0.91 0.67 to 1.23 0.92 0.68 to 1.24 0.92 0.67 to 1.26 Model 2 Other demographic characteristics Age (in yr) 0.98 0.97 to 0.99 0.99 0.98 to 1.00 Medical factors Charlson Comorbidity Index 0.82 0.75 to 0.90 0.85 0.77 to 0.93 Model 3 Final status after KASc 4.17 3.03 to 5.73 Cultural factors Overall religiosityd 0.93 0.88 to 0.98 Psychosocial characteristics Social supportd 1.03 1.00 to 1.05 Transplant knowledge and education Number of learning activitiesd 1.10 1.02 to 1.19 Higher value, greater amount (or higher score) on a particular variable. KAS, Kidney Allocation System; DDKT, deceased-donor kidney transplant; LDKT, living-donor kidney transplant; SHR, subdistribution hazard ratio.
↵a Main event, received DDKT; competing event, LDKT, died; censoring, still on waitlist or other removal; missing, unknown donor type.
↵b Sample size used for Models 1, 2, and 3: n=1036 (i.e., those with complete data on all variables; 231 received a transplant, 525 died, 280 censored).
↵c Final status after KAS refers to whether the patient’s ultimate outcome (i.e., transplant, died, censored) occurred either before or after the KAS policy changes of 2014 to all of the tables that include this variable.
↵d The SHR for these variables are per one-point higher in each scale.
- Table 4.
Fine-Gray proportional subdistribution hazards model for time from evaluation to receiving a living-donor kidney transplanta (n=961)b
Variables Model 1 Model 2 Model 3 Subdistribution Hazard Ratio 95% Confidence Interval Subdistribution Hazard Ratio 95% Confidence Interval Subdistribution Hazard Ratio 95% Confidence Interval Model 1 Race/ethnicity Non-Hispanic White 1 (ref) 1 (ref) Non-Hispanic Black 0.28 0.14 to 0.53 0.42 0.22 to 0.83 0.49 0.26 to 0.95 Model 2 Other demographic characteristics Age (in yr) 0.98 0.96 to 0.99 0.98 0.96 to 0.99 Household income (<US$50,000) 0.52 0.34 to 0.81 0.59 0.38 to 0.92 Insurance status Private only 1 (ref) 1 (ref) Public only 0.31 0.16 to 0.58 0.32 0.17 to 0.60 Public and private 0.47 0.29 to 0.76 0.46 0.28 to 0.75 Medical factors BMI 0.97 0.94 to 0.99 0.96 0.93 to 0.99 Type of dialysis None 1 (ref) 1 (ref) Hemodialysis 0.49 0.31 to 0.79 0.52 0.33 to 0.84 Peritoneal dialysis 0.43 0.21 to 0.88 0.43 0.21 to 0.86 Have a potential living donor at T1 (yes) 3.98 2.34 to 6.79 3.67 2.15 to 6.26 Model 3 Cultural factors Religious objection to living-donor kidney transplant 0.02 No objection 1 (ref) Mixed 0.45 0.19 to 1.04 Any objection 0.62 0.42 to 0.92 Transplant knowledge and education Transplant knowledgec 1.12 1.02 to 1.23 Higher value, greater amount (or higher score) on a particular variable. BMI, body mass index; DDKT, deceased-donor kidney transplant; LDKT, living-donor kidney transplant; SHR, subdistribution hazard ratio.
↵a Main event, received LDKT; competing event, DDKT, died; censoring, still on waitlist or other removal; missing, unknown donor type.
↵b Sample size used for Models 1, 2, and 3: n=961 (i.e., those with complete data on all variables; 117 received a transplant, 585 died, 259 censored).
↵c The SHR for this variable is per one-point higher in the scale.
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