The Early Steps to Transplant Access Registry (E-STAR) dashboard: center-specific reporting on prewaitlisting data to improve access to kidney transplantation.

Purpose of review: The 2022 National Academies of Sciences, Engineering, and Medicine report highlighted inequities in access to kidney transplantation and called for a comprehensive dashboard highlighting early transplant steps, yet data on steps such as referral and evaluation start are limited. Addressing this gap is crucial for improving equity in access to transplantation.

Recent findings: The Early Steps to Transplant Access Registry (E-STAR) provides a model for how prewaitlisting data can be used to inform quality improvement to drive equity in access to transplantation. E-STAR includes data from 37 transplant centers across 13 states and four regions (Southeast, New York, New England, and the Ohio River Valley), representing ∼217 000 adults with end-stage kidney disease (ESKD) treated in 4365 dialysis facilities, in addition to patients preemptively referred. Similar to the Scientific Registry of Transplant Recipients center-specific reports, the E-STAR dashboard was developed as an interactive website offering center-specific and regional insights into pretransplant access measures within and across centers with the intention to improve access to transplantation. Publicly available de-identified reports illustrate trends in referral, evaluation, and waitlisting by subgroup (e.g., race, sex, age, insurance status), while password-protected features enable transplant centers to benchmark their performance against anonymized peers.

Summary: The E-STAR dashboard demonstrates how centralized, standardized data collection can support transplant centers, policymakers, community partners, and regional organizations to identify disparities, drive quality improvement, and develop interventions for the advancement of equity in transplant access. This work may inform future center-specific reports once prewaitlisting data are collected nationally.