Eliminating racial disparities in kidney transplantation.

Kidney transplantation improves survival and quality of life among patients with kidney failure. Based on OPTN policy 8.4.A, non-dialysis candidates can accrue wait time once their GFR is ≤20 ml/min. Race coefficients in GFR estimation equations has been proposed as a cause for disparity in access to transplantation, specifically delaying transplant listing in Black individuals. Using SRTR data from 2017– 2020, we found a significant racial disparity between the proportion of candidates who were listed preemptively, with a higher proportion of White candidates compared to Black, Hispanic and other candidates (p<0.0001). Among White candidates, 39.4% were listed pre-emptively, by comparison, only 17.5% of Black candidates, 18.5% of Hispanic candidates, and 26.0% of other race candidates, were listed pre-emptively. Our findings that only a small portion of Blacks were listed for kidney transplantation pre-emptively highlights the importance of early referral for transplant evaluation and imply that changes to eGFR calculation by removal of race coefficient for listing purposes may have limited effects. More focus is needed on other steps along the path to kidney transplantation to achieve higher impact on dismantling racial inequities, including early referral, education and support for timely evaluation completion, and mitigation of biases in GFR estimation.