Racial and ethnic disparities in kidney transplantation

Abstract

Social determinants of health, bias and genetic predisposition contribute to racial inequities in chronic kidney disease (CKD) and kidney transplant (KTX) allocation. Recognizing and addressing these complex factors leads to improvement in outcomes. This narrative review aims to discuss the current state of racial disparities surrounding KTX and identify where future efforts should be concentrated. The discussion focuses on data from the past 10 years (2015–2025). Overall mortality and graft loss is lowest in Hispanics and Asians and highest in Native Americans, perhaps due to the unique protective or detrimental social factors in these populations. Blacks have equal to better mortality than Whites, but worse graft survival. In an effort to identify paucities in the current literature, KTX outcomes by specific CKD etiologies are reviewed, including: diabetic nephropathy, focal segmental glomerulosclerosis, membranous nephropathy, lupus nephritis, vasculitis and polycystic kidney disease. Graft survival and mortality patterns for disease specific kidney transplant generally mirrors that of all cause KTX, but available data is limited. In recent years, racial disparities in CKD and transplant have improved, but still persist, representing the need for continued investigation and improvement. Future work should focus on continued identification and implementation of successful mitigation strategies and investigation where current literature is insufficient, such as diabetic nephropathy.