Understanding ethnic and gender disparities in solid organ transplantation has been previously shown to have social and clinical implications. While general disparities at the national level have been mostly studied, it is not clear how generalizable these broad observations are across other levels of the U.S. organ transplant community, particularly in clinical trials, individual centers, and across states. Here, we investigate disparities by comparing gender and ethnic trends from clinical trials and studies in the ImmPort database (https://immport.niaid.nih.gov/), with UCSF electronic health records (EHR), and the U.S. national registry, hosted by the United Network for Organ Sharing (UNOS), for kidney living donors (LDs) and recipients (RPs). We found that 70% of the UNOS kidney transplant LDs are of European ancestry, compared to 43.4% in the UCSF EHR, and 87% LDs in ImmPort. We also observe discrepancies in gender and ethnic trends across clinical-trial, national and center-specific data within the LD and RP populations, especially when we stratify by the age of donation. Our analyses suggest that, while general trends at the national level are useful in painting a broad scenario, they are not necessarily reflective of the kidney transplant populations in clinical trials and various centers. The implications are two-fold: (1) inferences from the results of clinical trials might not be immediately applicable to all transplant populations, which can vary in ethnic and gender composition; (2) strategies in LD and clinical trial recruitment should incorporate and reflect local gender and ethnic shortfalls and disparities.
University of California, San Francisco (UCSF)