{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T20:07:36Z","timestamp":1786133256766,"version":"build-2736575974"},"reference-count":22,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"10","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JASN"],"published-print":{"date-parts":[[2018,10]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The process for evaluating kidney transplant candidates and applicable centers is distinct for patients with Veterans Administration (VA) coverage. We compared transplant rates between candidates on the kidney waiting list with VA coverage and those with other primary insurance.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Using the Scientific Registry of Transplant Recipients database, we obtained data for all adult patients in the United States listed for a primary solitary kidney transplant between January 2004 and August 2016. Of 302,457 patients analyzed, 3663 had VA primary insurance coverage.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>VA patients had a much greater median distance to their transplant center than those with other insurance had (282 versus 22 miles). In an adjusted Cox model, compared with private pay and Medicare patients, VA patients had a hazard ratio (95% confidence interval) for time to transplant of 0.72 (0.68 to 0.76) and 0.85 (0.81 to 0.90), respectively, and lower rates for living and deceased donor transplants. In a model comparing VA transplant rates with rates from four local non-VA competing centers in the same donor service areas, lower transplant rates for VA patients than for privately insured patients persisted (hazard ratio, 0.72; 95% confidence interval, 0.65 to 0.79) despite similar adjusted mortality rates. Transplant rates for VA patients were similar to those of Medicare patients locally, although Medicare patients were more likely to die or be delisted after waitlist placement.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>After successful listing, VA kidney transplant candidates appear to have persistent barriers to transplant. Further contemporary analyses are needed to account for variables that contribute to such differential transplant rates.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1681\/asn.2017111204","type":"journal-article","created":{"date-parts":[[2018,7,13]],"date-time":"2018-07-13T15:35:57Z","timestamp":1531496157000},"page":"2574-2582","source":"Crossref","is-referenced-by-count":11,"title":["Significantly Lower Rates of Kidney Transplantation among Candidates Listed with the Veterans Administration: A National and Local Comparison"],"prefix":"10.1681","volume":"29","author":[{"given":"Joshua J.","family":"Augustine","sequence":"first","affiliation":[{"name":"Department of Nephrology and Hypertension, Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio;"},{"name":"Division of Nephrology, Louis Stokes Veterans Administration Hospital, Cleveland, Ohio;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susana","family":"Arrigain","sequence":"additional","affiliation":[{"name":"Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Krishna","family":"Balabhadrapatruni","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Louis Stokes Veterans Administration Hospital, Cleveland, Ohio;"},{"name":"Case Western University School of Medicine, Cleveland, Ohio; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Niraj","family":"Desai","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Louis Stokes Veterans Administration Hospital, Cleveland, Ohio;"},{"name":"Case Western University School of Medicine, Cleveland, Ohio; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jesse D.","family":"Schold","sequence":"additional","affiliation":[{"name":"Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio;"},{"name":"Center for Populations Health Research, Cleveland, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2018,7,13]]},"reference":[{"key":"B1-20230829","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1186\/1472-6963-13-26","article-title":"Comparison of outcomes for veterans receiving dialysis care from VA and non-VA providers.","volume":"13","author":"Wang","year":"2013","journal-title":"BMC Health Serv Res"},{"key":"B2-20230829","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1111\/ajt.14119","article-title":"Transplantation remains daunting for many veterans.","volume":"17","author":"Pullen","year":"2017","journal-title":"Am J Transplant"},{"key":"B3-20230829","doi-asserted-by":"crossref","first-page":"476","DOI":"10.1016\/j.amjsurg.2003.07.024","article-title":"Survival and quality of life after organ transplantation in veterans and nonveterans.","volume":"186","author":"Moore","year":"2003","journal-title":"Am J Surg"},{"key":"B4-20230829","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1681\/ASN.2004040333","article-title":"Influence of race on kidney transplant outcomes within and outside the Department of Veterans Affairs.","volume":"16","author":"Chakkera","year":"2005","journal-title":"J Am Soc Nephrol"},{"key":"B5-20230829","doi-asserted-by":"crossref","first-page":"1463","DOI":"10.1097\/TP.0000000000000543","article-title":"Understanding patient barriers to kidney transplant evaluation.","volume":"99","author":"Dageforde","year":"2015","journal-title":"Transplantation"},{"key":"B6-20230829","doi-asserted-by":"crossref","first-page":"1951","DOI":"10.1111\/ajt.12948","article-title":"The AJT report.","volume":"14","author":"Pondrom","year":"2014","journal-title":"Am J Transplant"},{"key":"B7-20230829","doi-asserted-by":"crossref","first-page":"2592","DOI":"10.1681\/ASN.2007010050","article-title":"Access to kidney transplantation among patients insured by the United States Department of Veterans Affairs.","volume":"18","author":"Gill","year":"2007","journal-title":"J Am Soc Nephrol"},{"key":"B8-20230829","doi-asserted-by":"crossref","first-page":"2526","DOI":"10.1111\/ajt.12860","article-title":"The role of minority geographic distribution in waiting time for deceased donor kidney transplantation.","volume":"14","author":"Vranic","year":"2014","journal-title":"Am J Transplant"},{"key":"B9-20230829","doi-asserted-by":"crossref","first-page":"1012","DOI":"10.1111\/ajt.12143","article-title":"Trends in the inactive kidney transplant waitlist and implications for candidate survival.","volume":"13","author":"Grams","year":"2013","journal-title":"Am J Transplant"},{"key":"B10-20230829","doi-asserted-by":"crossref","first-page":"2374","DOI":"10.1111\/ajt.12349","article-title":"Prominent impact of community risk factors on kidney transplant candidate processes and outcomes.","volume":"13","author":"Schold","year":"2013","journal-title":"Am J Transplant"},{"key":"B11-20230829","doi-asserted-by":"crossref","first-page":"1321","DOI":"10.1681\/ASN.2013060658","article-title":"State medicaid coverage, ESRD incidence, and access to care.","volume":"25","author":"Kurella-Tamura","year":"2014","journal-title":"J Am Soc Nephrol"},{"key":"B12-20230829","doi-asserted-by":"crossref","first-page":"2276","DOI":"10.2215\/CJN.04940610","article-title":"The interplay of socioeconomic status, distance to center, and interdonor service area travel on kidney transplant access and outcomes.","volume":"5","author":"Axelrod","year":"2010","journal-title":"Clin J Am Soc Nephrol"},{"key":"B13-20230829","first-page":"36796","article-title":"Beneficiary travel under 38 U.S.C. 111 within the Unites. 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