Racial and immunologic disparities impact access to kidney rewaitlisting and retransplantation

The number of patients with a failed kidney transplant who are being considered for retransplantation is steadily increasing. However, disparities in access to repeat waitlisting and retransplant have not been well described. We examined a cohort of 102 891 patients with a failed kidney transplant in the United States Renal Data System (1995-2022) and assessed access to repeat waitlisting and repeat transplantation. Approximately half of the study population was relisted after graft failure, including similar proportions of White (49.6%), Black (46.8%), and Hispanic patients (49.9%). There were no differences in rewaitlisting of either Black (hazard ratio [HR], 1.00; 95% confidence interval [CI], 0.97-1.02) or Hispanic (HR, 1.01; 95% CI, 0.98-1.04) patients regardless of sociodemographics or clinical covariables. Interestingly, White patients had a higher rate of retransplantation (30.9%) than Black (20.8%; HR, 0.67; 95% CI, 0.65-0.69) or Hispanic (26.8%; HR, 0.78; 95% CI, 0.75-0.81) patients when sociodemographics or clinical covariables were controlled. When stratified by recipient panel reactive antibody, racial disparities were reduced; however, moderate and highly sensitized Black and Hispanic patients had reduced access to retransplant from the waiting list. Access to the waitlist alone does not account for racial/ethnic differences in retransplantation; policies and strategies addressing both sociodemographic and immunologic disparities should be promoted to improve access to kidney retransplant for minority patients.