Health Disparities
Middle Eastern and North African Individuals in Kidney Transplantation Jesse Howell* Jesse Howell Alejandro Diez Oscar K. Serrano Anne Zehner
Purpose: Current federal standards for race/ethnicity data collection group Middle Eastern and North African (MENA) persons in the white racial/ethnic category. This has generated objections from MENA Americans who believe their experiences are not accurately reflected in this group. In 2023, the Office of Management and Budget proposed revising the standards. We reviewed Organ Procurement and Transplantation Network (OPTN) data to determine if there are disparities between MENA and non-MENA individuals in kidney transplantation.
Methods: We analyzed kidney (KI) registrations waiting on the OPTN waiting list (WL) and KI transplant (TX) recipients from 01/01/2018–12/31/2022. We filtered to those in the White, non-Hispanic race/ethnicity category (White alone) and U.S. residents, while excluding multiorgan listings and transplants. We grouped patients who reported Arab/Middle Eastern or North African race/ethnicity within the White alone category as MENA. All other White alone patients were grouped as non-MENA. We used Kaplan-Meier estimates for graft survival.
Results: In the White alone category, 1.9% (n=2411) of KI WL registrations and 1.7% (n=798) of KI TX recipients were MENA. MENA recipients were more likely to have delayed graft function (24.9%) compared to the non-MENA group (15.4%), though 6-month graft survival was similar. MENA registrations had higher median dialysis time at listing (134 days vs. 23 days). A higher proportion of non-MENA WL removals were for living donor TX (17.4% vs. 13.2%), and a higher proportion of MENA removals were for deceased donor TX (32.93% vs. 29.12%).
Conclusion: There were differences between the MENA and non-MENA groups, such as a higher chance of delayed graft function, but despite these differences, graft survival remained similar. The biggest barrier to transplantation is getting on the WL and disparities may be present prior to listing, as evidenced by the 111 added days in median dialysis time at listing for MENA candidates.