Access to Transplant for African American and Latino Patients under the 2014 US Kidney Allocation System

Background. Kidney transplant offers better outcomes and reduced costs compared with chronic dialysis. However, racial and ethnic disparities in access to kidney transplant persist despite efforts to expand access to transplant and improve the equity of deceased donor allocation. Our objective was to evaluate after listing the association of race and ethnicity with access to deceased donor kidney transplant (DDKT) after changes to the allocation system in 2014. Methods. This retrospective study evaluated access to DDKT after listing since the implementation of the 2014 kidney allocation system. Waitlist status and transplant outcomes were ascertained from data from the Scientific Registry of Transplant Recipients. Our analysis included every adult kidney transplant candidate on the waiting list in the US from January 1, 2015, through June 30, 2023. Results. A total of 290 763 candidates were on the waiting list for DDKT during the study period. Of these, 36.4% of candidates were African American and 22.2% were Latino. Compared with White non-Latino patients, access to DDKT after listing was reduced for African American (unadjusted hazard ratio [HR], 0.93; 95% confidence interval [CI], 0.92-0.94) and Latino individuals (unadjusted HR, 0.88; 95% CI, 0.87-0.90). After controlling for demographic and clinical factors, these differences in access to transplant widened substantially for African American (HR, 0.78; 95% CI, 0.77-0.80) and Latino patients (HR, 0.73; 95% CI, 0.72-0.74). Conclusions. African American and Latino patients had reduced access to DDKT after listing. More effective approaches to improving access for African American and Latino individuals after listing are needed.