Public Release: 

Language barriers may interfere with access to kidney transplantation

English language fluency may be an important predictor of patients' status on the transplant waiting list

American Society of Nephrology

Washington, DC (February 9, 2017) -- Language barriers may hinder US kidney transplant candidates' access to kidney transplantation, according to a study appearing in an upcoming issue of the Clinical Journal of the American Society of Nephrology (CJASN). The findings suggest that patients who primarily speak a language other than English may face disparities that keep them from completing their kidney transplant evaluation and ultimately receiving a kidney transplant.

Individuals in need of a kidney transplant can get on a transplant waiting list, but if they are "inactive," they are not eligible to receive a deceased donor kidney. The main reason for inactive status is, by far, incomplete transplant evaluations. In other words, the patient does not complete the testing required to make them "active" or eligible for a kidney. There are many potential reasons why a candidate might be delayed in completing the testing required for transplant evaluation.

A team led by Ed Huang, MD (Cedars-Sinai Medical Center) and Efrain Talamantes, MD (University of California Davis School of Medicine) looked to see if language barriers, or linguistic isolation, might impact access to the active transplant waiting list. The researchers merged Organ Procurement and Transplantation Network/United Network for Organ Sharing data with 5-digit zip code socioeconomic data from the 2000 United States census. They then determined the cumulative incidence of conversion to active waitlist status, death, and delisting before conversion among 84,783 temporarily inactive adult kidney candidates from 2004-2012. A household was determined to be linguistically isolated if all members ?14 years old speak a non-English language and also speak English less than "very well."

Across all racial/ethnic groups, progressively higher degrees of linguistic isolation were linked with a lower likelihood of transitioning from inactive to active status on the kidney transplant waiting list and with incomplete transplant evaluations. Candidates living in a community with >20% linguistically isolated households were 29% less likely to achieve active waitlist status than those residing in a community with <1% linguistically isolated households. The associations of linguistic isolation and other socioeconomic factors appeared to be most influential among Hispanic candidates.

"Our data suggest that language barriers may limit an individual's ability to receive a kidney transplant. We recommend that patients with limited English proficiency who are in need of a kidney transplant use patient advocates who are English-proficient during transplant clinic visits and always use interpreters to get all of their questions answered," said Dr. Huang. "Further, transplant centers and healthcare providers should actively address potential communication barriers when recommending testing for transplant evaluation."

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Study co-authors include Keith Norris, MD, Carol Mangione, MD, Gerardo Soto, MD, Amy Waterman, PhD, John Peipert, and Suphamai Bunnapradist, MD.

Disclosures: Dr. Efrain Talamantes was supported by the Health Resources and Services Administration (HRSA) Institutional National Research Service Award (NRSA) at the University of California, Los Angeles (UCLA), grant no. T32HP19001, and the UCLA and Charles Drew University (CDU), Resource Centers for Minority Aging Research Center for Health Improvement of Minority Elderly (RCMAR/CHIME) under NIH/NIA Grant P30-AG021684, and from the UCLA Clinical and Translational Science Institute (CTSI) under NIH/NCATS Grant Number UL1TR000124. Dr. Carol Mangione received support from the University of California at Los Angeles (UCLA), Resource Centers for Minority Aging Research Center for Health Improvement of Minority Elderly under National Institutes of Health (NIH)/NIA under Grant P30AG021684, by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) of the NIH under Grant R18DK105464, the Centers for Disease Control and Prevention (CDC) under Grant U18DP006140 and from NIH/National Center for Advancing Translational Sciences UCLA Clinical and Translational Science Institute under Grant UL1TR000124. Dr. Mangione holds the Barbara A. Levey and Gerald S. Levey Endowed Chair in Medicine, which partially supported her work. Dr. Carol Mangione is a member of the United States Preventive Services Task Force (USPSTF). This article does not necessarily represent the views and policies of the USPSTF. Dr. Gerardo Moreno received support from a National Institute on Aging (K23 AG042961-01) Paul B. Beeson Career Development Award, the American Federation for Aging Research, and the UCLA Resource Center for Minority Aging Research/Center for Health Improvement of Minority Elderly (RCMAR/CHIME) under NIH/NIA grant P30AG021684. The content does not necessarily represent the official views of the NIA or the NIH. This work was supported in part by HRSA contract no. 231-00-0115. The content is the responsibility of the authors alone and does not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. government.

The article, entitled "Linguistic Isolation and Access to the Active Kidney Transplant Waiting list in the United States," will appear online at http://cjasn.asnjournals.org/ on February 9, 2017, doi: 10.2215/CJN.07150716.

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