Impact of Medicaid expansion on kidney transplantation in the State Oklahoma  

作　　者：Hyoshin Kwon Zoya Sandhu Zoona Sarwar Oya M Andacoglu 

机构地区：[1]Department of Surgery,Division of Transplantation,Ou College of Medicine,OK 73104,United States [2]Department of Internal Medicine,University of Oklahoma,Tulsa School of Community Medicine,Tulsa,OK 74135,United States [3]Department of Surgery,University of Oklahoma College of Medicine,Oklahoma,OK 73104,United States [4]Department of Transplantation and Advanced Hepatobiliary Surgery,University of Utah,Salt Lake,UT 84112,United States

出　　处：《World Journal of Transplantation》2024年第3期110-119,共10页世界移植杂志

摘　　要：BACKGROUND There is no data evaluating the impact of Medicaid expansion on kidney tran-splants(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 reci-pients 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.

关 键 词：Medicaid expansion OKLAHOMA Kidney transplant 

分 类 号：R699.2[医药卫生—泌尿科学]