Transplant Referral and Long-Term Kidney Allograft Survival for Black Patients: Single-Center Study.

Background: Despite improvements in access to transplantation there remains disparities in all aspects of transplant among minority patients. We sought to examine referral practices and long-term outcomes of kidney transplantation across racial identities at our center.

Study design: We conducted a retrospective review of kidney transplant (KT) recipients from 01/2010 to 05/2024. Data was obtained from UNOS and confirmed with the electronic medical record. Patients were categorized as White, Black, Asian, Hispanic, (HI/PI), and (AI/AN).

Results: 1369 patients met criteria. 67% White, 6.9% Black, 7.9% Asian, 14.1% Hispanic, 2.6% (HI/PI), and 1.5% (AI/AN). There were no significant between group differences in (KDPI), (EPTS), recipient or donor age or (CMV) status, cold ischemia time, time from referral to evaluation or listing. There was a significant difference in waiting time for Black compared to White patients (733.6 vs. 595.4 days, p = 0.026). Black patients had higher mean creatinine at 6 mo. and 1 year compared to all others (1.6 vs. 1.3 mg/dL at both time points, p < 0.001). After adjusting for baseline characteristics, Blacks had an increased risk of allograft loss at 15 years compared to White patients (p < 0.001) and were to receive a living donor transplant (10.5% vs. 25.3%, p < 0.01) or a preemptive KT (10.5% vs. 27.0%, p < 0.01).

Conclusions: Despite disproportionate representation among patients with chronic kidney disease, compared to age-matched White patients, Black patients at our center are referred for transplant later and have a higher rate of 10-year allograft loss. It is up to us to focus on education and to close the gap and improve outcomes for all of our transplant recipients.