Equitable Access to Kidney Transplantation: Assessing the Effects of Race-Neutral eGFR Calculations
*Amir Ebadinejad MD1, *Juan P. Cobar MD1, *Pamela Cyr-Long 2, Wasim Dar MD2, *Bishoy Emmanuel MD2, Glyn Morgan MD2, Oscar K. Serrano 2
1Department of Surgery, Hartford Hospital, Hartford, CT; 2Transplant & Comprehensive Liver Center, Hartford Hospital, Hartford, CT
Introduction
In July 2022, the Organ Procurement Transplant Network (OPTN) mandated race-neutral eGFR calculations, replacing historic race-based estimates. Subsequently, this change required transplant programs to identify kidney transplant (KT) candidates who could have benefitted from an earlier waitlist qualification date using race-neutral calculations.
Methods
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 waiting times (N=26) were compared to two control groups: Black patients without modifications (N=21) and non-Black patients (N=89). Postoperative outcomes, including complications and readmission rates, were analyzed across groups.
Results
Of 126 Black patients evaluated, 60.3% qualified for waiting time modifications, with a median gain of 570 days (12 to 3,500 days) totaling 62,057 days. Within six months, 26 patients (34%) received a KT, mostly from deceased donors (92%) with a median kidney donor profile index (KDPI) of 66%. Black patients with modifications had significantly higher BMI, diabetes, and peripheral vascular disease compared to controls. Readmission rates were higher among Black patients with modifications, though no significant differences in graft loss or mortality were observed.
Conclusions
Race-neutral eGFR recalculations substantially improved waiting time for Black KT candidates, addressing historical disparities. However, higher comorbidities and readmissions among these patients suggest the need for thorough readiness evaluations for waitlist activation.
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