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Tong J, Shen Y, Xu A, He X, Luo C, Edmondson M, Zhang D, Lu Y, Yan C, Li R, Siegel L, Sun L, Shenkman EA, Morton SC, Malin BA, Bian J, Asch DA, Chen Y. Evaluating site-of-care-related racial disparities in kidney graft failure using a novel federated learning framework. J Am Med Inform Assoc 2024; 31:1303-1312. [PMID: 38713006 PMCID: PMC11105132 DOI: 10.1093/jamia/ocae075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 01/09/2024] [Accepted: 03/26/2024] [Indexed: 05/08/2024] Open
Abstract
OBJECTIVES Racial disparities in kidney transplant access and posttransplant outcomes exist between non-Hispanic Black (NHB) and non-Hispanic White (NHW) patients in the United States, with the site of care being a key contributor. Using multi-site data to examine the effect of site of care on racial disparities, the key challenge is the dilemma in sharing patient-level data due to regulations for protecting patients' privacy. MATERIALS AND METHODS We developed a federated learning framework, named dGEM-disparity (decentralized algorithm for Generalized linear mixed Effect Model for disparity quantification). Consisting of 2 modules, dGEM-disparity first provides accurately estimated common effects and calibrated hospital-specific effects by requiring only aggregated data from each center and then adopts a counterfactual modeling approach to assess whether the graft failure rates differ if NHB patients had been admitted at transplant centers in the same distribution as NHW patients were admitted. RESULTS Utilizing United States Renal Data System data from 39 043 adult patients across 73 transplant centers over 10 years, we found that if NHB patients had followed the distribution of NHW patients in admissions, there would be 38 fewer deaths or graft failures per 10 000 NHB patients (95% CI, 35-40) within 1 year of receiving a kidney transplant on average. DISCUSSION The proposed framework facilitates efficient collaborations in clinical research networks. Additionally, the framework, by using counterfactual modeling to calculate the event rate, allows us to investigate contributions to racial disparities that may occur at the level of site of care. CONCLUSIONS Our framework is broadly applicable to other decentralized datasets and disparities research related to differential access to care. Ultimately, our proposed framework will advance equity in human health by identifying and addressing hospital-level racial disparities.
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Affiliation(s)
- Jiayi Tong
- The Center for Health AI and Synthesis of Evidence (CHASE), Perelman School of Medicine, The University of Pennsylvania, Philadelphia, PA 19104, United States
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, The University of Pennsylvania, Philadelphia, PA 19104, United States
| | - Yishan Shen
- The Center for Health AI and Synthesis of Evidence (CHASE), Perelman School of Medicine, The University of Pennsylvania, Philadelphia, PA 19104, United States
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, The University of Pennsylvania, Philadelphia, PA 19104, United States
- Applied Mathematics and Computational Science, The University of Pennsylvania, Philadelphia, PA 19104, United States
| | - Alice Xu
- The Center for Health AI and Synthesis of Evidence (CHASE), Perelman School of Medicine, The University of Pennsylvania, Philadelphia, PA 19104, United States
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, The University of Pennsylvania, Philadelphia, PA 19104, United States
- Washington University in St. Louis, St. Louis, MO 63130, United States
| | - Xing He
- Department of Health Outcomes & Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL 32611, United States
| | - Chongliang Luo
- Division of Public Health Sciences, Department of Surgery, Washington University in St. Louis, St. Louis, MO 63110, United States
| | | | - Dazheng Zhang
- The Center for Health AI and Synthesis of Evidence (CHASE), Perelman School of Medicine, The University of Pennsylvania, Philadelphia, PA 19104, United States
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, The University of Pennsylvania, Philadelphia, PA 19104, United States
| | - Yiwen Lu
- The Center for Health AI and Synthesis of Evidence (CHASE), Perelman School of Medicine, The University of Pennsylvania, Philadelphia, PA 19104, United States
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, The University of Pennsylvania, Philadelphia, PA 19104, United States
| | - Chao Yan
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN 37203, United States
| | - Ruowang Li
- Department of Computational Biomedicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048, United States
| | - Lianne Siegel
- Division of Biostatistics and Health Data Science, School of Public Health, University of Minnesota, Minneapolis, MN 55414, United States
| | - Lichao Sun
- Department of Computer Science and Engineering, Lehigh University, Bethlehem, PA 18015, United States
| | - Elizabeth A Shenkman
- Department of Health Outcomes & Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL 32611, United States
| | - Sally C Morton
- School of Mathematical and Statistical Sciences, Arizona State University, Tempe, AZ 85287, United States
| | - Bradley A Malin
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN 37203, United States
- Department of Computer Science, Vanderbilt University, Nashville, TN 37212, United States
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN 37203, United States
| | - Jiang Bian
- Department of Health Outcomes & Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL 32611, United States
| | - David A Asch
- Division of General Internal Medicine, University of Pennsylvania, Philadelphia, PA 19104, United States
- Leonard Davis Institute of Health Economics, Philadelphia, PA 19104, United States
| | - Yong Chen
- The Center for Health AI and Synthesis of Evidence (CHASE), Perelman School of Medicine, The University of Pennsylvania, Philadelphia, PA 19104, United States
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, The University of Pennsylvania, Philadelphia, PA 19104, United States
- Applied Mathematics and Computational Science, The University of Pennsylvania, Philadelphia, PA 19104, United States
- Leonard Davis Institute of Health Economics, Philadelphia, PA 19104, United States
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Magyar CTJ, Gretener CP, Baldi P, Storni F, Kim-Fuchs C, Candinas D, Berzigotti A, Knecht M, Beldi G, Hirzel C, Sidler D, Reineke D, Banz V. Recipient donor sex combinations in solid organ transplantation and impact on clinical outcome: A scoping review. Clin Transplant 2024; 38:e15312. [PMID: 38678586 DOI: 10.1111/ctr.15312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 02/22/2024] [Accepted: 03/25/2024] [Indexed: 05/01/2024]
Abstract
INTRODUCTION Solid organ transplantation (SOT) is a lifesaving treatment for end-stage organ failure. Although many factors affect the success of organ transplantation, recipient and donor sex are important biological factors influencing transplant outcome. However, the impact of the four possible recipient and donor sex combinations (RDSC) on transplant outcome remains largely unclear. METHODS A scoping review was carried out focusing on studies examining the association between RDSC and outcomes (mortality, graft rejection, and infection) after heart, lung, liver, and kidney transplantation. All studies up to February 2023 were included. RESULTS Multiple studies published between 1998 and 2022 show that RDSC is an important factor affecting the outcome after organ transplantation. Male recipients of SOT have a higher risk of mortality and graft failure than female recipients. Differences regarding the causes of death are observed. Female recipients on the other hand are more susceptible to infections after SOT. CONCLUSION Differences in underlying illnesses as well as age, immunosuppressive therapy and underlying biological mechanisms among male and female SOT recipients affect the post-transplant outcome. However, the precise mechanisms influencing the interaction between RDSC and post-transplant outcome remain largely unclear. A better understanding of how to identify and modulate these factors may improve outcome, which is particularly important in light of the worldwide organ shortage. An analysis for differences of etiology and causes of graft loss or mortality, respectively, is warranted across the RDSC groups. PRACTITIONER POINTS Recipient and donor sex combinations affect outcome after solid organ transplantation. While female recipients are more susceptible to infections after solid organ transplantation, they have higher overall survival following SOT, with causes of death differing from male recipients. Sex-differences should be taken into account in the post-transplant management.
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Affiliation(s)
- Christian Tibor Josef Magyar
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Charlene Pierrine Gretener
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Patricia Baldi
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Federico Storni
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Corina Kim-Fuchs
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Daniel Candinas
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Annalisa Berzigotti
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Matthias Knecht
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Guido Beldi
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Cédric Hirzel
- Department of Infectious Diseases, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Daniel Sidler
- Department for Nephrology and Hypertension, University Hospital Insel Bern, Bern, Switzerland
| | - David Reineke
- Department of Cardiac Surgery, Inselspital, University of Bern, Bern, Switzerland
| | - Vanessa Banz
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Doby BL, Knechtle SJ, Locke JE. HRSA's Patient-Centric Approach to Modernizing the US Transplant System. JAMA Surg 2023; 158:1239-1241. [PMID: 37755865 DOI: 10.1001/jamasurg.2023.3217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/28/2023]
Abstract
This Viewpoint discusses the benefits of modernization efforts for the US transplant system.
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Affiliation(s)
- Brianna L Doby
- Positive Rhetoric, Bowling Green, Kentucky
- Department of Public Health Sciences, College of Health, Education, and Social Transformation, New Mexico State University, Las Cruces
| | - Stuart J Knechtle
- Duke Transplant Center, Department of Surgery, Duke University School of Medicine, Durham, North Carolina
| | - Jayme E Locke
- Comprehensive Transplant Institute, University of Alabama at Birmingham
- Department of Surgery, University of Alabama at Birmingham
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Alhamad T, Marklin G, Ji M, Rothweiler R, Chang SH, Wellen J. One-Year Experience With the New Kidney Allocation Policy at a Single Center and an OPO in the Midwestern United States. Transpl Int 2022; 35:10798. [PMID: 36568140 PMCID: PMC9767943 DOI: 10.3389/ti.2022.10798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 11/28/2022] [Indexed: 12/12/2022]
Affiliation(s)
- Tarek Alhamad
- Division of Nephrology, School of Medicine, Washington University in St. Louis, St. Louis, MO, United States,*Correspondence: Tarek Alhamad,
| | - Gary Marklin
- Mid-America Transplant Organ Procurement Organization, St. Louis, MO, United States
| | - Mengmeng Ji
- Division of Nephrology, School of Medicine, Washington University in St. Louis, St. Louis, MO, United States
| | - Richard Rothweiler
- Mid-America Transplant Organ Procurement Organization, St. Louis, MO, United States
| | - Su-Hsin Chang
- Division of Public Health Sciences, Department of Surgery, School of Medicine, Washington University in St. Louis, St. Louis, MO, United States
| | - Jason Wellen
- Department of Surgery, School of Medicine, Washington University in St. Louis, St. Louis, MO, United States
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Potluri VS, Bloom RD. Effect of Policy on Geographic Inequities in Kidney Transplantation. Am J Kidney Dis 2021; 79:897-900. [PMID: 34974033 DOI: 10.1053/j.ajkd.2021.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 11/18/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Vishnu S Potluri
- Renal, Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19131
| | - Roy D Bloom
- Renal, Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19131.
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Affiliation(s)
- Nicole A Turgeon
- Department of Surgery, University of Texas Dell Medical School, Austin, TX
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Jindra PT, Shah MB, Shafer TJ, Van Buren CT, Siminoff LA. Systemic Racism Harms Black Americans' Access to Kidney Transplantation and Full Participation in Organ Donation. Prog Transplant 2021; 31:394-397. [PMID: 34693826 DOI: 10.1177/15269248211046000] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
| | - Malay B Shah
- 12252University of Kentucky College of Medicine, Lexington, KY, USA
| | | | | | - Laura A Siminoff
- College of Public Health, 6558Temple University, Philadelphia, PA, USA
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DuBay DA, Morinelli TA, Su Z, Mauldin P, Weeda E, Casey MJ, Baliga P, Taber DJ. Association of High Burden of End-stage Kidney Disease With Decreased Kidney Transplant Rates With the Updated US Kidney Allocation Policy. JAMA Surg 2021; 156:639-645. [PMID: 34037705 PMCID: PMC8156168 DOI: 10.1001/jamasurg.2021.1489] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 02/13/2021] [Indexed: 11/14/2022]
Abstract
Importance The Organ Procurement and Transplantation Network (OPTN) approved changes to the US kidney allocation system in 2019. The potential effects of this policy change using transplant rates normalized to end-stage kidney disease (ESKD) incidence have not been investigated. Objective To estimate how the OPTN kidney allocation policy will affect areas of the US currently demonstrating low rates of kidney transplant, when accounting for the regional burden of ESKD. Design, Setting, and Participants This cross-sectional population-based economic evaluation analyzed access of patients with ESKD to kidney transplant in the US. Participants included patients with incident ESKD, those on the kidney transplant wait list, and those who received a kidney transplant. Data were collected from January 1 to December 31, 2017, and were analyzed in 2019. Main Outcomes and Measures The probability of a patient with ESKD being placed on the transplant wait list or receiving a deceased donor kidney transplant. States and donor service areas (DSAs) were compared for gains and losses in rates of transplanted kidneys under the new allocation system. Transplant rates were normalized for ESKD burden. Results A total of 122 659 patients had incident ESKD in the US in 2017 (58.2% men; mean [SD] age, 62.8 [15.1] years). The probability of a patient with ESKD receiving a deceased donor kidney transplant varied 3-fold across the US (from 6.36% in West Virginia to 18.68% in the District of Columbia). Modeling of the OPTN demonstrates that DSAs from New York (124%), Georgia (65%), and Illinois (56%) are estimated to experience the largest increases in deceased donor kidney allocation. Other than Georgia, these states have kidney transplant rates per incident ESKD cases above the mean (of 50 states plus the District of Columbia, New York is 16th and Illinois is 24th). In contrast, DSAs from Nevada (-74%), Ohio (-67%), and North Carolina (-61%)-each of which has a transplant rate per incident ESKD cases significantly below the mean-are estimated to experience the largest decreases in deceased donor allocation (of 50 states plus the District of Columbia, North Carolina is 34th, Ohio is 38th, and Nevada is 47th). Conclusions and Relevance The new OPTN-approved kidney allocation policy may result in worsening geographic disparities in access to transplants when measured against the burden of ESKD within a particular region of the US.
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Affiliation(s)
- Derek A. DuBay
- Division of Transplant Surgery, Department of Surgery, Medical University of South Carolina, Charleston
| | - Thomas Anthony Morinelli
- Division of Transplant Surgery, Department of Surgery, Medical University of South Carolina, Charleston
| | - Zemin Su
- General Internal Medicine/Geriatrics, Department of Medicine, Medical University of South Carolina, Charleston
| | - Patrick Mauldin
- General Internal Medicine/Geriatrics, Department of Medicine, Medical University of South Carolina, Charleston
| | - Erin Weeda
- Department of Clinical Pharmacy and Outcomes Sciences, Medical University of South Carolina, Charleston
| | - Michael J. Casey
- Division of Nephrology, Department of Medicine, Medical University of South Carolina, Charleston
| | - Prabhaker Baliga
- Division of Transplant Surgery, Department of Surgery, Medical University of South Carolina, Charleston
| | - David J. Taber
- Division of Transplant Surgery, Department of Surgery, Medical University of South Carolina, Charleston
- Pharmacy Department, Ralph H. Johnson VA Medical Center, Department of Veterans Affairs, Charleston, South Carolina
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O'Connor K, Glazier AK, Nathan H. Effects of Geographic Redistribution Policy on Access to Organ Transplant. JAMA Surg 2021; 156:287-288. [PMID: 33237322 DOI: 10.1001/jamasurg.2020.5300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Hanaway MJ, MacLennan PA, Locke JE. Effects of Geographic Redistribution Policy on Access to Organ Transplant-Reply. JAMA Surg 2021; 156:289-290. [PMID: 33237314 DOI: 10.1001/jamasurg.2020.5315] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Michael J Hanaway
- University of Alabama at Birmingham Comprehensive Transplant Institute
| | - Paul A MacLennan
- University of Alabama at Birmingham Comprehensive Transplant Institute
| | - Jayme E Locke
- University of Alabama at Birmingham Comprehensive Transplant Institute
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Wilk AR, Stewart DE, Snyder J. Effects of Geographic Redistribution Policy on Access to Organ Transplant. JAMA Surg 2021; 156:288-289. [PMID: 33237309 DOI: 10.1001/jamasurg.2020.5303] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Amber R Wilk
- United Network for Organ Sharing, Richmond, Virginia
| | | | - Jon Snyder
- Hennepin Healthcare Research Institute, Minneapolis, Minnesota
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