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

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.

We conducted a retrospective review of kidney transplantation recipients from January 2010 to May 2024. Data were obtained from United Network for Organ Sharing and confirmed with the electronic medical record. Patients were categorized as White, Black, Asian, Hispanic, Hawaiian/Pacific Islander, and American Indian/Alaska Native.

A total of 1,369 patients met criteria with 67% White, 6.9% Black, 7.9% Asian, 14.1% Hispanic, 2.6% Hawaiian/Pacific Islander, and 1.5% American Indian/Alaska Native. There were no significant between group differences in kidney donor profile index, expected posttransplant survival, recipient or donor age or cytomegalovirus status, cold ischemia time, and time from referral to evaluation or listing. There was a significant difference in waiting time for Black compared with White patients (733.6 vs 595.4 days, p = 0.026). Black patients had higher mean creatinine at 6 months and 1 year compared with all others (1.6 vs 1.3 mg/dL at both time points, p < 0.001). After adjusting for baseline characteristics, Black patients had an increased risk of allograft loss at 15 years compared with White patients (p < 0.001) and were to receive a living donor transplant (10.5% vs 25.3%, p < 0.01) or a preemptive kidney transplantation (10.5% vs 27.0%, p < 0.01).

Despite disproportionate representation among patients with chronic kidney disease, compared with 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 close the gap and improve outcomes for all of our transplant recipients.