Published online Sep 18, 2024. doi: 10.5500/wjt.v14.i3.92981
Revised: May 4, 2024
Accepted: May 23, 2024
Published online: September 18, 2024
Processing time: 167 Days and 11.7 Hours
There is no data evaluating the impact of Medicaid expansion on kidney tran
To investigate the impact of Medicaid expansion on KT patients in Oklahoma.
The UNOS database was utilized to evaluate data pertaining to adult KT reci
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).
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.
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.