Disparities in Kidney Transplantation Access and Outcomes among Native Hawaiians and Pacific Islanders in the United States
Kiyonari Noguchi, Linda L. Wong, Christie H. Izutsu, Connie M. Rhee, Lung-Yi (Felix) LeeBackground:
Native Hawaiian and Pacific Islander (NHPI) individuals are an underrepresented population with a disproportionate burden of ESKD. Many NHPI individuals are of multiple races, yet studies frequently aggregate them into other racial and ethnic groups, masking important differences in outcomes.
Methods:
We conducted a retrospective cohort study of all adult, kidney-only, waitlisted candidates in the Organ Procurement and Transplantation Network (OPTN) dataset (December 2014 – December 2022) comparing NHPI individuals, including multiracial individuals with NHPI ancestry, with White and other racial and ethnic groups on their waitlist and transplant outcomes. Waiting time to transplantation was assessed using competing risk analyses, accounting for waitlist removal. Death-censored graft survival and transplant survival were assessed using the Kaplan-Meier method and Cox proportional hazards model.
Results:
Among 313,033 candidates, 1800 were of NHPI ancestry (1521 single race, 279 multiracial). NHPI candidates were younger, had higher body mass index, and were more likely to have diabetes. Most were listed in OPTN regions 5 (50%) and 6 (25%). Compared to White and other racial and ethnic groups, NHPI candidates were more likely to be inactive on the waitlist (NHPI candidates: 19% vs. White candidates: 12%;
Conclusions:
NHPI individuals demonstrated unique demographic and geographic characteristics associated with reduced transplant access but comparable post-transplant outcomes. Further work is needed to improve transplant access in this unique and underrepresented population.