Kidney Transplant Referral Patterns

Kidney transplantation is the optimal treatment for patients with end-stage kidney disease. Long-standing racial and socioeconomic disparities in kidney transplant outcomes result from inequities in access to each step in the multi-step transplant process—from referral for transplant evaluation, evaluation start and completion, transplant waitlisting, and receipt of a living- or deceased-donor kidney transplant.

In 2010, the Southeastern United States was identified as having the highest burden of kidney disease, the highest number of Black patients on dialysis, and the lowest rate of kidney transplant in the nation, leading to the formation of the Southeastern Kidney Transplant (SEKTx) Coalition. The SEKTC has since facilitated sustained collaboration of key stakeholders in the kidney disease community toward the common goals of improving transplant rates and eliminating inequities in access to kidney transplantation in the Southeast through quality improvement efforts, multi-component interventions, and policy initiatives.

The increasing reach and stakeholder engagement has allowed SEKTC to develop the nation’s only data repository containing information on all steps in the kidney transplant pathway, several of which are not captured elsewhere in US surveillance data. The Early Transplant Access Registry dataset supports research efforts that have identified socioeconomic-, geographic-, racial and ethnic-, and sex-based disparities in patients’ likelihood of progressing through each step in the kidney transplant pathway with an emphasis on barriers to referral and evaluation. With more partners across ten additional states joining in, the SEKTC is developing a new online hub for replicable quality improvement interventions and advanced, interactive data visualization tools. These novel resources will serve as valuable tools for health-system-level learning, problem identification, and quality improvement initiatives among SEKTC partner organizations, and support research and interventions that continue to identify and address the factors that contribute to disparities in access to kidney transplantation.

The Kidney Transplant Referral Patterns project uses geocoded data from the Early Transplant Access Registry to visualize spatial and temporal variations in patient travel to dialysis facilities and transplant centers and in patterns of dialysis facilities referrals for transplant evaluation to transplant centers. This new resource will be used to develop program-specific reports intended to be used by individual transplant programs to help with outreach to improve access to transplantation. Not only do these tools offer a never-before-seen perspective on the geography of key clinical interactions, they will allow researchers to study complex multi-level relationships that contribute to differential patient access to and experiences in the kidney transplant pathway.