Retrospective Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Transplant. Sep 18, 2024; 14(3): 92981
Published online Sep 18, 2024. doi: 10.5500/wjt.v14.i3.92981
Impact of Medicaid expansion on kidney transplantation in the State Oklahoma
Hyoshin Kwon, Zoya Sandhu, Zoona Sarwar, Oya M Andacoglu
Hyoshin Kwon, Department of Surgery, Division of Transplantation, Ou College of Medicine, OK 73104, United States
Zoya Sandhu, Department of Internal Medicine, University of Oklahoma, Tulsa School of Community Medicine, Tulsa, OK 74135, United States
Zoona Sarwar, Oya M Andacoglu, Department of Surgery, University of Oklahoma College of Medicine, Oklahoma, OK 73104, United States
Oya M Andacoglu, Department of Transplantation and Advanced Hepatobiliary Surgery, University of Utah, Salt Lake, UT 84112, United States
Co-first authors: Hyoshin Kwon and Zoya Sandhu.
Author contributions: Kwon H, Sandhu Z, Andacoglu OM, and Sarwar Z designed the project together; Sarwar Z collected the data and provided Tables and Figures; Kwon H, Sandhu Z and Andacoglu OM interpreted results together, contributing to the results/discussion and conclusion sections of the manuscript. All authors drafted and reviewed the manuscript. Kwon H and Sandhu Z are co-first authors because they contributed to most manuscript drafting, data analysis and submission together. Equal effort and time were spent by both Kwon H and Sandhu Z to create this manuscript. Kwon H and Sandhu Z were essential to the submission and communication between all team members. Designating Kwon H and Sandhu Z as co-first authors recognize the amount of time, energy and resources that these authors dedicated to this manuscript.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of University of Oklahoma Health Sciences Center.
Informed consent statement: Informed consent was not applicable to this study.
Conflict-of-interest statement: There were no conflicts of interest by any author in this study.
Data sharing statement: The data that support this study are available in Scientific Registry of Transplant Recipients at https://srtr.transplant.hrsa.gov/annual_reports/Default.aspx. Consent was not obtained because this data is publicly available and with no identifiable factors included, therefore risk of identification is low.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Oya M Andacoglu, MD, Associate Professor, Attending Doctor, Researcher, Department of Transplantation and Advanced Hepatobiliary Surgery, University of Utah, 30 N Mario Capecchi Drive, Salt Lake, UT 84112, United States. dr.oyaandacoglu@gmail.com
Received: February 14, 2024
Revised: May 4, 2024
Accepted: May 23, 2024
Published online: September 18, 2024
Processing time: 167 Days and 11.7 Hours
Abstract
BACKGROUND

There is no data evaluating the impact of Medicaid expansion on kidney transplants (KT) in Oklahoma.

AIM

To investigate the impact of Medicaid expansion on KT patients in Oklahoma.

METHODS

The UNOS database was utilized to evaluate data pertaining to adult KT recipients in Oklahoma in the pre-and post-Medicaid eras. Bivariate analysis, Kaplan Meier analysis was used to estimate, and cox proportional models were utilized.

RESULTS

There were 2758 pre- and 141 recipients in the post-Medicaid expansion era. Post-expansion patients were more often non-United States citizens (2.3% vs 5.7%), American Indian, Alaskan, or Pacific Islander (7.8% vs 9.2%), Hispanic (7.4% vs 12.8%), or Asian (2.5% vs 8.5%) (P < 0.0001). Waitlist time was shorter in the post-expansion era (410 vs 253 d) (P = 0.0011). Living donor rates, pre-emptive transplants, re-do transplants, delayed graft function rates, kidney donor profile index values, panel reactive antibodies levels, and insurance types were similar. Patients with public insurance were more frail. Despite increased early (< 6 months) rejection rates, 1-year patient and graft survival were similar. In Cox proportional hazards model, male sex, American Indian, Alaskan or Pacific Islander race, public insurance, and frailty category were independent risk factors for death at 1 year. Medicaid expansion was not associated with graft failure or patient survival (adjusted hazard ratio: 1.07; 95%CI: 0.26-4.41).

CONCLUSION

Medicaid expansion in Oklahoma is associated with increased KT access for non-White/non-Black and non-United States citizen patients with shorter wait times. 1-year graft and patient survival rates were similar before and after expansion. Medicaid expansion itself was not independently associated with graft or patient survival outcomes. Ongoing research is necessary to determine the long-term effects of Medicaid expansion.

Keywords: Medicaid expansion; Oklahoma; Kidney transplant

Core Tip: The Medicaid Expansion had a significant impact on several kidney transplant (KT) recipients in Oklahoma. There was greater access to KTs for non-white population (Hispanics, Asians, American Indian, Alaskan, or Pacific Islanders), and Non-United States citizens. Male sex, race, frailty category and insurance type were associated with increased mortality at 1 year after transplant. Medicaid expansion was not associated with 1 year outcomes, however, further research is needed to investigate the long-term impact of Medicaid expansion on Oklahoma.