Majority Rules? Assessing Access to Kidney Transplantation in a Predominantly Hispanic Population

Key Points In a Hispanic-majority population, Hispanic patients with CKD experience delayed transplant evaluation and waitlisting compared with White patients. Waitlisted Hispanic patients undergo fewer kidney transplants from all donor types and less preemptive transplantation than White patients. Despite greater comorbidity profiles, Hispanic patients on the kidney transplant waitlist have a lower attrition rate compared with White patients. Background Despite being the nation's largest ethnic minority, Hispanic Americans have inferior kidney transplant opportunities. San Antonio, TX, is the largest US city with a majority Hispanic population. We assessed the effect of this unique ethnic milieu on waitlisting and transplant practices among Hispanic patients. Methods We studied patients older than 18 years listed at our center for a kidney-only transplant between 2003 and 2022. Timing of waitlisting, transplant rates, and waitlist outcomes were compared between Hispanic and non-Hispanic White patients. Results We evaluated 11,895 patients, of whom 67% ( n =8008) were Hispanic and 20% ( n =2341) were White. Preemptive listing was less frequent in Hispanic patients (18% versus 37%). One third of the listed Hispanic patients (37%) and half of listed White patients (50%) were transplanted, with living donor kidney transplant performed in 59% ( n =1755) and 77% ( n =898), respectively. Adjusting for age, sex, blood type, preemptive listing, immunologic sensitization, education, employment, and listing era, Hispanic patients remained less likely to receive a deceased donor transplant (hazard ratio, 0.82; 95% confidence interval, 0.71 to 0.95). On covariate adjustment, White patients were more likely to experience waitlist death or deterioration (hazard ratio, 1.23; 95% confidence interval, 1.12 to 1.36). Conclusions Although waitlist attrition was more favorable among Hispanic patients, waitlist registration was delayed and kidney transplants less frequent compared with White patients. These data demonstrate that majority status alone does not mitigate ethnic disparities in kidney transplantation, while underlining the critical need for ongoing efforts to address physician and patient attitudes relating to suitability of Hispanic patients for transplantation.