I’m pulling material from two sources today: the OPTN dataset I requested, and an article recently published by Cherikh (see citation) to look at minority living kidney donors and their risk of end-stage renal disease and/or being wait listed in need of their own transplant.
Those are two different things because not everyone who is diagnosed with ESRD is wait listed. Some are content on dialysis and some choose not to have a transplant. Some receive a ‘pre-emptive’ transplant are never wait listed.
According to my data set, from 1994 through March 2010:
124 or 43.5% of LKDs wait listed were White.
117 or 41.1% – Black.
29 or 10.2% – Hispanic.
7 or 2.5% – Asian.
5 or 1.8% – American Indian/Alaska Native
1 or .4% – Hawaiian or other Pacific Islander
2 or .75 – Multiracial
Contrast that with the total number of living donors, according to OPTN’s site:
75,640 or 70.6% – white
13,753 or 12.8% – black
13,078 or 12.2% – hispanic
109 or .01% – ubiquitous unknown
2831 or 2.6% – asian
663 or .6% – alaskan/native american
615 or .57% – pacific islander
499 or .46% – multiracial
Sooooo….. African-Americans compose 12.8% of total living donors, yet make up 41.4% of LKDs waitlisted.
Here’s where Cherikh’s analysis of LKDs with end-stage renal disease comes in. She only looked at a sample of total LKD population because (if I haven’t said a hundred times before) UNOS/OPTN only started collecting identifying info in 1994, so it is limited, but it says alot about those living kidney donors at risk for ESRD disease within a short period of time (less than 20 years).
Under 35yoa at time of donation:
50.3% of all black LKDs (compared to 32.9% white)
67.8% of black LKDs with ESRD. (compared to 24.1% white)
Evidence has been building about the correlation between age at time of donation and increased risk factors for kidney and cardiac disease. This cooroborates the suspicion that the more years spent with reduced kidney function, the greater the risk of developing these conditions.
62.7% of black LKDs with end-stage renal disease were 35-49yoa when diagnosed with a mean age of 42.6. White LKDs with ESRD, meanwhile, had a mean age of 56.3.
Years from donation to ESRD for black LKDs:
18.6% – 0-5yrs (>10% white)
37.3% – 6-10yrs (33.3% white)
25.4% – 11-14yrs (40.7% white)
Not only are black LKDs significantly younger than white LKDs at time of donation, they are at a much higher risk of ESRD at a much earlier age. There are many possible reasons for this: hereditary/genetic kidney disease factors, diabetic tendencies, access to healthcare, lifestyle, etc. and it’s impossible to speculate based on these numbers.
It does, however, stress the need for greater informed consent and closer scrutiny during evaluation, as well as the importance of follow-up care and lifestyle maintainence post-donation.
Cherikh WS, Young CJ, Kramer BF, Taranto SE, Randall HB, & Fan PY (2011). Ethnic and Gender Related Differences in the Risk of End-Stage Renal Disease After Living Kidney Donation. American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons PMID: 21672160