Appraisal of Impact of Race-Neutral Estimated Glomerular Filtration Rate Waiting Time Modification on Transplant Wait Time and Outcomes for Black Kidney Candidates: Importance of Transplant Readiness on the Waitlist.

Abstract

In July 2022, the Organ Procurement Transplant Network mandated race-neutral estimated glomerular filtration rate (eGFR) calculations when evaluating kidney transplantation (KT) candidates, replacing historic race-based estimates. This modification also required transplant programs to identify KT candidates on their waitlist who would have benefitted from an earlier waitlist qualification date using race-neutral calculations. This retrospective study analyzed Black patients listed for KT at our center between 2000 and 2023, recalculating their eGFR using race-neutral formulas. KT recipients with modified wait times (N = 26) were compared with 2 control groups: Black recipients without modifications (N = 21) and non-Black recipients (N = 89). Postoperative outcomes, including complications and readmission rates, were analyzed across groups. Of 126 Black patients evaluated, 60.3% qualified for wait time modifications, with a median gain of 570 days (1.6 years) per patient, totaling 62,057 days (180.7 years). Within 6 months of receiving additional time, 26 patients (34%) were transplanted, mostly from deceased donors (92%) with a median kidney donor profile index of 66%. Black KT recipients with modifications had significantly higher BMI, diabetes, and peripheral vascular disease compared with controls. Readmission rates were higher among Black KT recipients with modifications, although no significant differences in graft loss or mortality were observed. Race-neutral eGFR recalculations substantially improved Black KT candidates' ability to receive a KT, addressing historical disparities in KT. However, higher comorbidities and readmissions among these patients suggest the need for thorough transplant readiness evaluations before waitlist activation.