Racial/ethnic disparities in waitlisting for deceased donor kidney transplantation 1 year after implementation of the new national kidney allocation system

Am J Transplant. 2018 Aug;18(8):1936-1946. doi: 10.1111/ajt.14748. Epub 2018 Apr 18.


The impact of a new national kidney allocation system (KAS) on access to the national deceased-donor waiting list (waitlisting) and racial/ethnic disparities in waitlisting among US end-stage renal disease (ESRD) patients is unknown. We examined waitlisting pre- and post-KAS among incident (N = 1 253 100) and prevalent (N = 1 556 954) ESRD patients from the United States Renal Data System database (2005-2015) using multivariable time-dependent Cox and interrupted time-series models. The adjusted waitlisting rate among incident patients was 9% lower post-KAS (hazard ratio [HR]: 0.91; 95% confidence interval [CI], 0.90-0.93), although preemptive waitlisting increased from 30.2% to 35.1% (P < .0001). The waitlisting decrease is largely due to a decline in inactively waitlisted patients. Pre-KAS, blacks had a 19% lower waitlisting rate vs whites (HR: 0.81; 95% CI, 0.80-0.82); following KAS, disparity declined to 12% (HR: 0.88; 95% CI, 0.85-0.90). In adjusted time-series analyses of prevalent patients, waitlisting rates declined by 3.45/10 000 per month post-KAS (P < .001), resulting in ≈146 fewer waitlisting events/month. Shorter dialysis vintage was associated with greater decreases in waitlisting post-KAS (P < .001). Racial disparity reduction was due in part to a steeper decline in inactive waitlisting among minorities and a greater proportion of actively waitlisted minority patients. Waitlisting and racial disparity in waitlisting declined post-KAS; however, disparity remains.

Keywords: epidemiology; ethics and public policy; ethnicity/race; health services and outcomes research; kidney transplantation/nephrology; organ allocation; organ procurement and allocation; quality of care/care delivery.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Cadaver
  • Ethnicity / statistics & numerical data*
  • Female
  • Follow-Up Studies
  • Health Plan Implementation*
  • Healthcare Disparities*
  • Humans
  • Kidney Transplantation / mortality*
  • Male
  • Middle Aged
  • Prognosis
  • Racial Groups
  • Registries
  • Resource Allocation / standards*
  • Survival Rate
  • Tissue Donors / supply & distribution*
  • Tissue and Organ Procurement / trends*
  • Transplant Recipients
  • Waiting Lists / mortality*
  • Young Adult