Introduction: Effective July 2022, kidney transplant centers were required to adjust waiting time for Black candidates using a new race-neutral eGFR (estimated glomerular filtration rate) calculation. Little has been reported about the impact and limitations of this policy change on transplant access for Black patients.
Methods: A retrospective, single-center, cross-sectional study was performed in 04/2024 on adult (> 18 years) kidney transplant candidates who were eligible for wait-time modification. Clinicodemographic data and adjusted dialysis start dates were extracted from the medical record. Descriptive statistics were performed.
Results: A total of 274 Black patients were eligible for a wait-time modification. Of these, 26 (9.5%) had been delisted, nine (3.3%) were deceased, 26 (9.5%) were already transplanted, and 104 (38.1%) did not have the required laboratory documentation available. In total, 109 (39.8%) candidates ultimately received wait-time modifications. Of the 109, mean age was 56 years old and 47 (42.7%) were female. Mean wait-time gained was 2.7 years (median, 1.7 years; range, 1 month-21 years). Total wait-time gained by Black patients at this center was 298.5 years. Patients who did not receive time back were more likely to have recent bloodwork from maintenance dialysis as the source of evaluated laboratory data (52.7% vs. 33.0%) (p < 0.001).
Conclusion: Removing race from the eGFR calculation expanded transplant access for Black patients with eligible patients receiving an average of 2.7 years of additional wait time at a large metropolitan center. However, wait-time recovery was limited by the availability of laboratory data, indicating that assistance with finding older lab values may help realize the full potential of this policy.
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