Ms Tennille Vitagliano1, Dr Nicole De La Mata1, Prof Kate Wyburn1,2, Dr Melanie Wyld1,3
1Faculty of Medicine and Health, University of Sydney, Sydney, Australia, 2Department of Renal Medicine, Royal Prince Alfred Hospital, Camperdown, Australia, 3Department of Renal Medicine, Westmead Hospital, Westmead, Australia
Biography:
Melanie Wyld (B.Econ(Hons) MBBS MBA MPH PhD FRACP) is a nephrologist at Westmead Hospital and senior lecturer in clinical epidemiology at the School of Public Health, Faculty of Medicine and Health, University of Sydney. She received her PhD ‘Health outcomes and cost-effectiveness in kidney disease’ in 2019 from the University of Sydney. She is a clinical researcher with research interests in living donor kidney transplantation and equity of access to care. She is the Chair of Equity Diversity and Inclusion Committee of ANZSN, Chair of TSANZ’s Living Donor Transplantation Working Group, and Chair of ANZDATA’s Living Donor Working Group.
Aim:
To examine how measures of disadvantage—including intersectional disadvantage—influence access to living donor kidney transplantation (LDKT) in Australia.
Background:
LDKT provides the best survival and quality-of-life outcomes for people with kidney failure. Understanding who does-and does not- get access is critical to addressing inequities in care.
Methods:
A national cohort study of ANZDATA registry (2006–2023) data to evaluate associations between clinically relevant variables and access to LDKT using Cox proportional hazards models. Key variables included sex, age, ethnicity, socioeconomic position, body mass index (BMI), comorbidity burden, cPRA, and cause of kidney failure. To explore intersectional disadvantage, two-way interaction terms were included.
Results:
Among 46,684 patients (37.5% female) who initiated kidney replacement therapy (KRT), there were 165,147 person-years of follow-up. Access to LDKT was markedly lower among Aboriginal & Torres Strait Islander (adjusted Hazard Ratio (aHR):0.19; 95%CI:0.13–0.27), Maori & Pacific Peoples (aHR:0.38; 95%CI:0.28–0.53), and Asian patients (aHR:0.52; 95%CI:0.46–0.58); those in the lowest socioeconomic quintile (aHR:0.60; 95%CI:0.54–0.66); patients with diabetes (aHR:0.71; 95%CI:0.60–0.84) or hypertension (aHR:0.67; 95%CI:0.57–0.78) as primary kidney disease; and those with obesity (aHR:0.71; 95%CI:0.65–0.77). There was no statistically significant difference in LDKT access by sex (female aHR:1.01; 95%CI:0.94-1.09) or intersectional disadvantage.
Conclusions:
Substantial inequities in access to LDKT exist across multiple dimensions of social and clinical disadvantage. Notably, unlike patterns observed in deceased donor waitlisting—where sex and intersectional disadvantage have demonstrated powerful effects—these factors did not show statistically significant associations in the LDKT context. This suggests differing barriers and facilitators between transplant pathways. While individual disadvantages remain impactful, the cumulative burden of disadvantage should not be overlooked. Addressing disparities requires targeted, culturally-informed, and system-level strategies tailored specifically to the unique context of LDKT.
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