Impact of Race on Transplantation in Autosomal Dominant Polycystic Kidney Disease.

BACKGROUND Autosomal dominant polycystic kidney disease (ADPKD) is the most common genetic cause of end-stage kidney disease (ESKD) and occurs without racial predilection. In general, non-White ESKD patients have less access to transplantation, especially living donor transplantation. We examined long-term outcomes of ADPKD-ESKD patients by self-reported race, with attention to the trajectory of Estimated Post-Transplant Survival (EPTS) scores over time. METHODS United Network for Organ Sharing Standard Transplant Analysis and Research files were used to identify 32,611 ADPKD transplant recipients between 1/2000-12/2022. EPTS scores were calculated from the date of waitlisting until transplantation occurred. Cumulative incidences of living and deceased transplantation were calculated and plotted. Cox models were made for graft failure and death, and a sub-distribution hazards model for graft failure accounted for death as a competing outcome, with adjustment for patient, donor, and transplant factors. RESULTS Compared to White ADPKD patients, all other groups had more dialysis years, more delayed graft function, and fewer living and pre-emptive transplants; mean EPTS scores were lower in African American (AA) and Hispanic patients at each timepoint on the waitlist. However, EPTS scores at the time of transplant was less likely to be <20% in AA and Hispanic patients, due to longer waiting time. AA patients had a significantly higher risk of graft failure with death as competing risk compared to White patients. Asian and Hispanic patients had similar graft survivals but better patient survival compared to White patients. CONCLUSIONS Waitlist experience, allograft quality, and post-transplant outcomes of patients with ADPKD are influenced by patient race.