Evidence map›Paper›PMID 40491054›Full record

SynthesisRenal failure2025

Health insurance and kidney transplantation outcomes in the United States: a systematic review and AI-driven analysis of disparities in access and survival.

Oscar A Garcia Valencia, Supawadee Suppadungsuk, Charat Thongprayoon, Yuh-Shan Ho, Noppachai Siranart, Wannasit Wathanavasin, Caroline C Jadlowiec, Shennen A Mao, Napat Leeaphorn, Karim M Soliman and 4 more

Abstract readSystematic Review
In one paragraph

Synthesis in Renal failure, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

14 authors.

Oscar A Garcia ValenciaDivision of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, USA.
Supawadee SuppadungsukDivision of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, USA.
Charat ThongprayoonDivision of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, USA.
Yuh-Shan HoTrend Research Centre, Asia University, Wufeng, Taiwan.
Noppachai SiranartDivision of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, USA.
Wannasit WathanavasinNephrology Unit, Department of Medicine, Charoenkrung Pracharak Hospital, Bangkok Metropolitan Administration, Bangkok, Thailand.
Caroline C JadlowiecDivision of Transplant Surgery, Department of Surgery, Mayo Clinic, Pheonix, AZ, USA.
Shennen A MaoDivision of Transplant Surgery, Department of Surgery, Mayo Clinic, Jacksonville, FL, USA.
Napat LeeaphornDivision of Transplant Surgery, Department of Surgery, Mayo Clinic, Jacksonville, FL, USA.
Karim M SolimanDepartment of Medicine, Division of Nephrology, Medical University of South Carolina, Charleston, SC, USA.ORCID 0000-0002-0960-2644
Hatem AliRenal and Transplant Department, University Hospitals of Wales, Cardiff, UK.
Pooja BudhirajaDivision of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Pheonix, AZ, USA.
Jing MiaoDivision of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, USA.
Wisit CheungpasitpornDivision of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundKidney transplantation is the preferred treatment for end-stage kidney disease (ESKD) in the United States, yet access and outcomes vary by insurance type, race, and socioeconomic status. This systematic review synthesizes U.S.-based evidence on how insurance coverage influences transplant waitlisting, access, and outcomes. AI-assisted analysis was used to quantify disparities and propose policy recommendations.

methodsA systematic review of MEDLINE, EMBASE, and the Cochrane Database (through November 2024) was conducted to identify studies on insurance-related disparities in U.S. kidney transplantation (PROSPERO: CRD42023484733). AI-assisted synthesis using o3-mini-high (2025) was employed to identify patterns and guide policy development.

resultsAmong 2,163 records, 14 studies met inclusion criteria. Patients with Medicare or Medicaid-particularly racial and ethnic minorities-had lower referral rates and higher transplant waitlist rejection compared to those with private insurance. Socioeconomic barriers such as low income and limited education further impaired access and worsened post-transplant outcomes. Publicly insured recipients had higher post-transplant mortality and graft failure rates. Loss of Medicare after 36 months was associated with reduced immunosuppressant adherence and increased rejection. Disparities were amplified by Medicaid expansion variability and inconsistent transplant center policies. AI-assisted analysis confirmed these disparities and generated policy proposals including standardized referral guidelines, lifelong immunosuppressant coverage, targeted financial aid, equity-linked incentives for transplant centers, and scalable digital health solutions.

conclusionInsurance type, race, and socioeconomic status significantly influence kidney transplant access and outcomes. AI-assisted analysis identified structural inequities and informed targeted policy strategies to advance transplant equity and support broader healthcare reform.

Indexed as

Healthcare DisparitiesHealth Services AccessibilityInsurance CoverageInsurance, HealthKidney Failure, ChronicKidney TransplantationGraft RejectionGraft SurvivalHumansMedicaidMedicareSocioeconomic FactorsUnited StatesWaiting Listsartificial intelligencehealth equityinsurance disparitiesKidney transplantationMedicare and Medicaidtransplant outcomes

Identifiers

PMID40491054
PMCPMC12152983

What Socratic holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.