Investigators have identified when during the transplant evaluation process racial disparities occur. Results of the new study comparing 23,499 Black and 36,730 White patients starting dialysis were presented during the American Society of Nephrology’s Kidney Week 2020 Reimagined virtual conference.

Compared with White patients, Black patients on dialysis were 23% more likely to be referred for kidney transplantation, but 18% less likely to be placed on transplant waiting lists and 53% less likely to receive a donated kidney, inclusive of deceased and living donor kidneys, Steven M. Brunelli, MD, MSCE, of Davita Clinical Research, Minneapolis, Minnesota, reported.

“Racial disparities seem to emerge beginning at the listing stage and carry through the organ allocation stage,” Dr Brunelli stated. Overall, Black patients were 55% less likely to receive a kidney transplant. Insurance type and dialysis modality did not meaningfully alter results, he said.

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Transplant rates varied across the 11 Organ Procurement and Transplantation Network (OPTN) regions, Dr Brunelli noted, but in no region were Black patients as likely as White patients to receive a kidney transplant.

In general, Black patients were younger than White patients (age 58.2 vs 64.1 years) and more likely to be female (47.6% vs 41.8%). More Black patients dialyzed with central venous catheters (77.3% vs 72.9%) and fewer dialyzed with an arteriovenous fistula (12.9% vs 16.5%) or peritoneal dialysis (5.2% vs 8.1%), respectively. Additionally, fewer Black patients received Medicare (53.4% vs 68.2%). Black patients also tended to have more disadvantages in terms of high school graduation rates, social associations, housing, and income, but not employment. Residual confounding by socioeconomic status could not be ruled out, however.

Among the study’s limitations, the analyses could not account for immune status, deceased vs living donor kidney outcomes, and pre-emptive transplant referral.

Disclosure: This study was supported by DaVita. Please see the original reference for a full list of authors’ disclosures.


Brunelli SM, Hunt A, Colson C, Tentori F. Exploration of racial disparities in the kidney transplant process among dialysis patients. Presented at: Kidney Week 2020 Reimagined, October 19-25, 2020. Poster SU-OR42.

Study reveals details behind transplant disparities experienced by Black patients [news release]. American Society of Nephrology. Washington DC; October 25, 2020.