77.08 Racial Disparities in Access to Kidney Transplantation: Insights from the Modern Era

K. Covarrubias¹, K. R. Jackson¹, J. H. Chen¹, C. M. Holscher¹, T. Purnell¹, A. B. Massie¹, D. L. Segev¹, J. M. Garonzik-Wang^{1  1}The Johns Hopkins University School Of Medicine,Surgery,Baltimore, MD, USA

Introduction: One goal of the new Kidney Allocation System (KAS) was to increase access to deceased donor kidney transplantation (DDKT) for racial and ethnic minorities, who prior to KAS had lower DDKT rates than Whites. Early studies after KAS implementation reported narrowing disparities in DDKT rates for Black and Hispanic candidates; however, it is unclear if these changes have translated into long-term equivalent DDKT rates for racial and ethnic minorities.

Methods: We studied 270,722 DDKT candidates using SRTR data from 12/4/2011–12/3/2014 (‘pre-KAS’) and 12/4/2014–12/3/2017 (‘post-KAS’), analyzing DDKT rates for Black, Hispanic, and Asian candidates using negative binomial regression, adjusting for candidate characteristics. We first determined whether DDKT rates for each race/ethnicity had improved post-KAS compared to pre-KAS, and then whether these changes had resulted in equivalent DDKT rates for minorities compared to Whites. We then calculated the cumulative incidence of DDKT for each race using a competing-risk framework.

Results: Post-KAS, Black candidates had an increased DDKT rate compared to pre-KAS (adjusted incidence rate ratio [aIRR]: _1.011.13_1.25, p=0.03). However, there were no post-KAS changes in DDKT rates for Hispanic (aIRR: _0.830.96_1.11, p=0.6) and a decrease in DDKT rates for Asian candidates (aIRR: _0.660.79_0.94, p=0.009). Relative to White candidates, KAS resulted in a similar DDKT rate for Black candidates (aIRR: _0.870.99­_1.12, p=0.9), but a decreased DDKT rate for Hispanic (aIRR: _0.560.74_0.98, p=0.04) and Asian (aIRR: _0.560.72_0.93, p=0.01) candidates. The range of likelihood of DDKT at 3-years for a given racial/ethnic minority decreased post-KAS (range 28.7-32.4%) compared to pre-KAS (range 27.0–34.3%). The 3-year cumulative incidence of DDKT improved post-KAS for Black (pre-KAS: 29.5%; post-KAS: 34.9%) and Hispanic candidates (pre-KAS: 27.0%; post-KAS: 30.5%). However, the 3-year cumulative incidence of DDKT remained similar for Asian candidates (pre-KAS: 29.0%; post-KAS: 28.7%), while it decreased for White candidates (pre-KAS: 34.3%; post-KAS: 31.6%).

Conclusion: KAS has produced sustained improvements in DDKT rates for Black candidates, but not for Hispanic or Asian candidates. Nevertheless, the cumulative incidence of DDKT has become more similar post-KAS. While KAS has been successful in improving access to DDKT for Blacks, further work is necessary to identify methods to improve DDKT rates for Hispanic and Asian candidates.