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Impact of Rural Residence on Kidney Transplant Rates Among Waitlisted Candidates in the VA Transplant Programs.

BACKGROUND
Although proportionally more veterans live in rural areas compared to non-veterans, the impact of rurality status on kidney transplantation (KTP) access among veterans is unknown. Our objective was to study KTP rates among veterans listed for KTP, and to compare the impact of rurality status on KTP rates among veterans and non-veterans.


METHODS
Retrospective cohort study of adult patients waitlisted per the United Network for Organ Sharing (UNOS) from January 2000 to December 2014. Patient characteristics were compared using chi-square or t-tests, as appropriate, by veteran status and patient rurality. Multivariable competing risks Cox regression was performed.


RESULTS
The study sample included 3,281 veterans receiving care in Veteran Health Administration (VHA) transplant programs and 445,177 non-veterans. Veterans, compared to non-veterans, were older (57 vs 50 years; p<0.001), more likely to be male (96% vs 60%; p<0.001) or diabetic at waitlisting (51% vs. 41%; p<0.001), and less likely be an urban resident (79% vs. 84%; p<0.001). Among veterans, dialysis duration prior to registration was longer among urban compared to all other rurality types (810 ± 22.1 days vs. 632-702 ± 41.6-77.6 days; p=0.02). In multivariate competing risks models, there was no evidence that the hazard of transplant among veterans differs by residential rurality.


CONCLUSIONS
Among waitlisted veterans served by VHA transplant programs, residential rurality status does not portend longer waiting time for KTP.