Geographic Disparities in Access to Simultaneous Pancreas and Kidney Transplant in the Pre- and Post-Pancreas Allocation System Eras

• Published in: Transplantation Vol. 104; no. 3; pp. 623 - 631
• Main Authors: Concepcion, Beatrice P., Feurer, Irene D., Rega, Scott A., Niederhaus, Silke, Odorico, Jon, Forbes, Rachel C.
• Format: Journal Article
• Language: English
• Published: United States Wolters Kluwer Health, Inc. All rights reserved 01-03-2020; Copyright Wolters Kluwer Health, Inc. All rights reserved
• Subjects: Adult; Diabetes Mellitus, Type 1 - surgery; Diabetes Mellitus, Type 2 - surgery; Female; Geography; Health Services Accessibility - organization & administration; Health Services Accessibility - standards; Health Services Accessibility - statistics & numerical data; Healthcare Disparities - organization & administration; Healthcare Disparities - statistics & numerical data; Humans; Kidney Transplantation - methods; Kidney Transplantation - standards; Kidney Transplantation - statistics & numerical data; Logistic Models; Male; Middle Aged; Pancreas Transplantation - methods; Pancreas Transplantation - standards; Pancreas Transplantation - statistics & numerical data; Patient Selection; Practice Guidelines as Topic; Program Evaluation; Registries - statistics & numerical data; Time Factors; Tissue and Organ Procurement - organization & administration; Tissue and Organ Procurement - standards; Tissue and Organ Procurement - statistics & numerical data; United States; United States Dept. of Health and Human Services - standards; United States
• ISSN: 0041-1337; 1534-6080
• DOI: 10.1097/TP.0000000000002850

BACKGROUND.The 2014 pancreas allocation system (PAS) intended to decrease geographic variability in listing practices for simultaneous pancreas and kidney (SPK) transplant and define eligibility criteria for those with type 2 diabetes mellitus (T2DM). Our primary aims were to evaluate geographic disparities in access to SPK and assess T2DM SPK listings in the pre- and post-PAS eras.
METHODS.Adult listings for SPK and kidney transplant (pre-PAS, January 2010 to October 29, 2014; post-PAS, October 30, 2014, to June 2, 2017) were identified in the Scientific Registry of Transplant Recipients. Multivariable logistic regression models tested associations of geography and/or diabetes mellitus type on the likelihood of SPK versus kidney transplant listing pre- and post-PAS. Competing risk models tested the likelihood of SPK transplantation within 2 years of listing for SPK.
RESULTS.Among 41 205 listings (27 393 pre-PAS; 24 439 T2DM), univariate analysis showed reduced percentages for SPK post-PAS (22.1%–20.8%; P = 0.003). After adjusting for patient and center characteristics, geographic disparities declined slightly but persisted post-PAS (era by region interaction P < 0.001). The era by type of diabetes mellitus interaction effect was statistically significant (P = 0.039), reflecting that the proportions of SPK listings for T2DM increased in the post-PAS era (3.4%–3.9%; univariate P = 0.038), while those for type 1 diabetes mellitus remained statistically stable (47.9%–48.4%; univariate P = 0.571). Among people listed for SPK, geographic disparities in the cumulative incidence of transplantation within 2 years declined and the overall likelihood of transplantation increased in the post-PAS era (both P < 0.001).
CONCLUSIONS.Geographic disparities in access to SPK declined slightly but persisted post-PAS. With new allocation change proposals and elimination of listing criteria for T2DM, further monitoring is warranted.