Effects of race-neutral estimated glomerular filtration rate policies on access to kidney transplantation.

Abstract

Motivated by potential inequities in access to transplantation stemming from the inclusion of Black race coefficients in estimated Glomerular Filtration Rate (eGFR) formulas, the United States Organ Procurement and Transplant Network (OPTN) implemented policies in 2022 and 2023 mandating the use of race-neutral eGFR formulas and the modification of waiting times for Black patients. We evaluated the impact of these policies on access to kidney transplantation using national registry data and supplementary OPTN data describing all waiting time modifications. The policy effects were assessed through segmented regression and difference-in-difference frameworks. There were no meaningful changes from the first mandate in the odds of a preemptively waitlisted patient being Black. The second mandate was associated with 3.8 [95% Confidence Interval: (2.7, 4.9), p-value < 0.001] additional deceased donor transplants per one-hundred person-years among the overall Black population, but 6.0 [95% Confidence Interval: (4.7, 7.3), p-value < 0.001] fewer deceased donor transplants per one-hundred person-years among the Black patients who did not receive waiting time modifications. There was evidence that the OPTN's second mandate had a positive impact on deceased donor transplant rates in the overall Black population but a negative impact on Black patients who did not receive additional waiting time.