Publication Spotlight: Dr. Lovasik

Interview with Brendan P. Lovasik, M.D., Abdominal Transplant Surgeon, Division of Transplant Surgery, Department of Transplantation, Mayo Clinic, senior author of Racial and immunologic disparities impact access to kidney rewaitlisting and retransplantation.

What question did your study aim to answer?

This study sought to determine if recipient sociodemographic and clinical disparities exist in access to kidney retransplantation, and if so, to determine the underlying etiologies of these disparities.

What inspired you to conduct this study?

Repeat kidney transplantation following a failed previous transplantation is one of the fastest-growing indications for kidney transplants, with nearly 12% of patients on the waiting list awaiting retransplant. Our research group has previously published on the significant barriers in access to first-time waitlisting and transplantation among Black and Hispanic patients in the United States. However, patients with a previous failed kidney transplant have unique issues that may influence their access for retransplantation, including immunologic sensitization and increased medical complexity, that may further influence their ability to receive a life-saving kidney transplant. We sought to determine if similar recipient sociodemographic and clinical disparities exist in access to kidney retransplantation.

Which USRDS datasets did you use to conduct your study?

We utilized the 2023 USRDS Standard Analysis Files (SAFs) to we identify 102,891 patients who received their primary kidney transplant between January 1, 1995, and August 31, 2022, and subsequently had a graft failure before August 31, 2022.

Using plain language, please summarize your study conclusions in two or three points.

In this national study of kidney transplant patients requiring retransplant, Black and Hispanic patients were less likely to undergo rewaitlisting and retransplantation than White patients. These racial/ethnic disparities in access to waitlisting were nearly eliminated when controlling for comorbidities and socioeconomic factors; however, there were still significant disparities in access to both deceased and living donor retransplantation even after patients were waitlisted. These findings suggest that immunologic factors may play a role in racial disparities in access to retransplantation and pose a significant barrier to minority patients receiving a repeat transplant even once they have been rewaitlisted.

Please share a specific insight about working with USRDS data that you learned during the completion of this study.

USRDS and its team of research coordinators are wonderful research partners. They are a pleasure to work with, and their dataset remains the best dataset for comprehensive analysis of kidney transplant patients in the United States. We have had an excellent collaboration.