Racial and Immunologic Disparities Impact Access to Kidney Re-Waitlisting and Retransplantation

The number of patients with a failed kidney transplant who are being considered for retransplantation is increasing steadily. However, disparities in access to repeat waitlisting and retransplant have not been well described. We examined a cohort of 102,891 patients with a failed kidney transplant in the United States Renal Data System (1995-2022), and assessed access to repeat wait-listing and repeat transplantation. Approximately half of the study population was re-listed after graft failure, including similar proportions of white (49.6%), and Black (46.8%), and Hispanic patients (49.9%). There were no differences in re-waitlisting of either Black (HR 1.00, 95% CI 0.97-1.02) or Hispanic (HR 1.01, 95% CI 0.98-1.04) patients regardless of sociodemographics or clinical covariables, Interestingly, White patients had a higher rate of retransplantation (30.9%) than Black (20.8%; HR 0.67, 95% CI 0.65-0.69) or Hispanic (26.8%; HR 0.78; 95% CI 0.75-0.81) patients when sociodemographics or clinical covariables were controlled. When stratified by recipient PRA, racial disparities were reduced; however, moderate and highly sensitized Black and Hispanic patients had reduced access to retransplant from the waiting list. Access to the waitlist alone does not account for racial/ethnic differences in retransplantation; policies and strategies addressing both sociodemographic and immunologic disparities should be promoted to improve access to kidney retransplant for minority patients.