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©The Author(s) 2024.
World J Transplant. Sep 18, 2024; 14(3): 92981
Published online Sep 18, 2024. doi: 10.5500/wjt.v14.i3.92981
Published online Sep 18, 2024. doi: 10.5500/wjt.v14.i3.92981
Table 1 Statistical analysis of pre-and post-Medicaid expansion in adult kidney transplant recipients for the state of Oklahoma
| Variables | Before medicaid expansion | After medicaid expansion | P value |
| Recipient age, median (IQR) | 53.0 (21.0) | 51.0 (22.0) | 0.3999c |
| Gender | |||
| Female | 1089 (39.5) | 56 (39.7) | 0.9563 |
| Male | 1669 (60.5) | 85 (60.3) | |
| Recipient BMI, Median (IQR) | 27.8 (7.6) | 28.4 (8.0) | 0.1549c |
| Race | |||
| White | 1708 (61.9) | 75 (53.2) | < 0.0001 |
| Black | 531 (19.3) | 22 (15.6) | |
| Amer Ind/Alaska Native/Pacific Islander | 215 (7.8) | 13 (9.2) | |
| Hispanic | 204 (7.4) | 18 (12.8) | |
| Asian | 68 (2.5) | 12 (8.5) | |
| Multiracial | 32 (1.2) | 1 (0.7) | |
| Citizenship at transplant | |||
| United States citizen | 2696 (97.8) | 133 (94.3) | 0.0188a |
| Non-United States citizen | 62 (2.3) | 8 (5.7) | |
| ESRD diagnosis | |||
| Other | 1423 (51.8) | 85 (60.3) | 0.0646 |
| Diabetes | 778 (28.3) | 26 (18.4) | |
| Hypertension | 546 (19.9) | 30 (21.3) | |
| History of a previous kidney transplant | 306 (11.1) | 14 (9.9) | 0.6665 |
| Recipient pretransplant dialysis | 2303 (83.9) | 110 (78.0) | 0.0673 |
| Initial calculated EPTS | |||
| < 20% | 2086 (75.6) | 61 (43.3) | < 0.0001 |
| ≥ 20% | 672 (24.4) | 80 (56.7) | |
| PRA, median (IQR) | 0.0 (27.0) | 0.0 (37.0) | 0.3133c |
| Recipient functional status at transplant | |||
| Able to carry on normal activity and to work. No special care needed | 2158 (80.6) | 11 (80.9) | 0.5848 |
| Unable to work; able to live at home and care for most personal needs; varying amount of assistance needed | 499 (18.6) | 27 (19.2) | |
| Unable to care for self; requires equivalent of institutional or hospital care; diseases may be progressing rapidly | 20 (0.8) | 0 (0.0) | |
| Recipient functional status-most recent at follow-up | |||
| Able to carry on normal activity and to work. No special care needed | 1025 (80.8) | 116 (82.3) | 0.1781 |
| Unable to work; able to live at home and care for most personal needs; varying amount of assistance needed | 197 (15.5) | 24 (17.0) | |
| Unable to care for self; requires equivalent of institutional or hospital care; diseases may be progressing rapidly | 46 (3.6) | 1 (0.7) | |
| Total days on waiting list/including inactive time, median (IQR) | 410.0 (683.0) | 253.0 (621.0) | 0.0011c |
| Donor type | |||
| Deceased donor | 2098 (76.1) | 111 (78.7) | 0.4705 |
| Living donor | 660 (23.9) | 30 (21.3) | |
| DCD donor | 469 (22.4) | 33 (29.7) | 0.0708 |
| Deceased donor kidney biopsy | 681 (32.5) | 46 (41.4) | 0.0497 |
| Donor kidney glomerulosclerosis, % | |||
| ≤ 20 | 709 (98.6) | 52 (100.0) | 1.0000a |
| > 20 | 10 (1.4) | 0 (0.0) | |
| HLA mismatch level | |||
| 0 | 199 (7.2) | 9 (6.4) | 0.0161 |
| 1 | 70 (2.5) | 1 (0.7) | |
| 2 | 203 (7.4) | 7 (5.0) | |
| 3 | 439 (16.0) | 21 (15.0) | |
| 4 | 678 (24.7) | 54 (38.6) | |
| 5 | 800 (29.1) | 31 (22.1) | |
| 6 | 362 (13.2) | 17 (12.1) | |
| Delayed graft function | 408 (14.8) | 27 (19.2) | 0.1578 |
| KDPI | |||
| Low < 20% | 648 (31.0) | 40 (36.0) | 0.4063 |
| Moderate 20%-85% | 1375 (65.7) | 69 (62.2) | |
| High > 85% | 69 (3.3) | 2 (1.8) | |
| KDPI, median (IQR) | 34.0 (40.0) | 34.0 (50.0) | 0.9930c |
| Share type | |||
| Local | 2437 (88.4) | 68 (48.2) | < 0.0001 |
| Regional | 101 (3.7) | 24 (17.0) | |
| National | 220 (8.0) | 49 (34.8) | |
| Kidney cold ischemic time (hours), median (IQR) | 12.0 (12.5) | 16.0 (12.9) | < 0.0001c |
| Rejection within 6 months | 176 (7.5) | 9 (16.4) | 0.0344a |
| Post TX | |||
| Recipient primary insurance at transplant | |||
| Private insurance | 835 (30.3) | 47 (33.3) | 0.5142b |
| Public insurance | 1921 (69.7) | 94 (66.7) | |
| Other | 2 (0.1) | 0 (0.0) | |
| Working for income | 876 (34.7) | 57 (42.2) | 0.0752 |
Table 2 Post-expansion recipient functional status at transplant by different insurance types
| Functional status at transplant | Private insurance (%) | Public insurance (%) | Other (%) | P value |
| Able to carry on normal activity and to work. No special care needed | 1083 (86.4) | 1184 (75.9) | 5 (100.0) | 0.0003b |
| Unable to work; able to live at home and care for most personal needs; varying amount of assistance needed | 168 (13.4) | 358 (23.0) | 0 (0.0) | |
| Unable to care for self; requires equivalent of institutional or hospital care; diseases may be progressing rapidly | 2 (0.2) | 18 (1.2) | 0 (0.0) |
Table 3 Post-Medicaid expansion recipients’ insurance types, n (%)
| Insurance | White 1783 (61.6) | Black 553 (19.1) | AI/NH/PI (0.08) | Hispanic (0.08) | Asian (0.03) | Multiracial (0.01) | P value |
| Private insurance | 905 (50.8) | 181 (32.7) | 91 (39.9) | 80 (36.0) | 35 (43.8) | 7 (21.2) | 0.0003 |
| Public insurance | 874 (49.0) | 371(67.1) | 137 (60.1) | 142 (64.0) | 45 (56.3) | 26 (78.8) | |
| Other | 4 (0.22) | 1 (0.18) | 0 (0.00) | 0 (0.00) | 0 (0.00) | 0 (0.00) |
Table 4 Post-expansion recipient functional status at Transplant by different race, n (%)
| Recipient functional status transplant | White 1783 (61.6) | Black 553 (19.1) | AI/NH/PI (0.08) | Hispanic (0.08) | Asian (0.03) | Multiracial (0.01) | P value |
| Able to carry on normal activity and to work. No special care needed | 1391 (80.5) | 435 (79.7) | 178 (81.3) | 178 (81.7) | 65 (85.5) | 25 (78.1) | 0.8401b |
| Unable to work; able to live at home and care for most personal needs; varying amount of assistance needed | 322 (18.7) | 108 (19.8) | 40 (18.3) | 39 (17.9) | 11 (14.5) | 6 (18.8) | |
| Unable to care for self; requires equivalent of institutional or hospital care; diseases may be progressing rapidly | 14 (0.81) | 3 (0.55) | 1 (0.46) | 1 (0.46) | 0 (0.00) | 1 (3.1) |
Table 5 Cox proportional hazards model for a hazard ratio of variables for 1-year patient survival
| Variables | aHR (95%CI) | P value |
| Age | 1.04 (1.03, 1.05) | < 0.0001 |
| Sex | ||
| Female | Reference | |
| Male | 1.19 (1.01, 1.40) | 0.0426 |
| Race | ||
| White | Reference | |
| Black | 0.98 (0.87, 1.20) | 0.8699 |
| Amer Ind/Alaska Native/Pacific Islander | 1.52 (1.18, 1.97) | 0.0014 |
| Hispanic | 0.82 (0.58, 1.17) | 0.2748 |
| Asian | 0.73 (0.40, 1.33) | 0.3056 |
| Multiracial | 1.05 (0.34, 3.32) | 0.9289 |
| Insurance | ||
| Private insurance | Reference | |
| Public insurance | 1.54 (1.25, 1.88) | < 0.0001 |
| Recipient functional status at transplant | ||
| Able to carry on normal activity and to work. No special care needed | Reference | |
| Unable to work; able to live at home and care for most personal needs; varying amount of assistance needed | 1.53 (1.27, 1.84) | < 0.0001 |
| Unable to care for self; requires equivalent of institutional or hospital care; diseases may be progressing rapidly | 2.13 (1.09, 4.20) | 0.0281 |
| Medicaid expansion | ||
| Before medicaid expansion | Reference | |
| After medicaid expansion | 1.07 (0.26, 4.41) | 0.9290 |
- Citation: Kwon H, Sandhu Z, Sarwar Z, Andacoglu OM. Impact of Medicaid expansion on kidney transplantation in the State Oklahoma. World J Transplant 2024; 14(3): 92981
- URL: https://www.wjgnet.com/2220-3230/full/v14/i3/92981.htm
- DOI: https://dx.doi.org/10.5500/wjt.v14.i3.92981