Preemptive Registration in Hispanic Kidney Transplant Candidates: When Is Early Not Early Enough?

Background: Preemptive registration promotes time accrual, waitlist priority, and an opportunity for preemptive kidney transplantation. Hispanic patients with kidney disease enjoy fewer preemptive waitlist registrations. We evaluated the fate of preemptively listed Hispanic kidney transplant candidates. Methods: We studied adult patients preemptively added to the kidney transplant waitlist at our center between 2003–2022, excluding multiorgan listings. Rates of transplantation, living donor kidney transplant (LDKT), preemptive transplant and dialysis initiation were compared in Hispanic vs. non-Hispanic White patients. Results: We evaluated 2,624 patients with a median age of 51 years and 58% were male. Hispanic patients accounted for 55% (1,452) and 33% (873) were White. Hispanics had more obesity and diabetes, but were less likely to have higher-level education or paid employment (all p<0.001). Overall 50% of Hispanics and 62% of Whites were transplanted, with Whites 75% more likely to be transplanted preemptively (both p<0.001). Hispanic were 40% less likely to have LDKT (OR 0.61) or preemptive LDKT (OR 0.59) (both p<0.001). Considering dialysis initiation as a time-dependent endpoint, Hispanics were 66% more likely than Whites to start dialysis after preemptive listing (Figure). Accounting for age, sex, diabetes, living donor availability and private insurance, Hispanic ethnicity independently predicted waitlist dialysis initiation (HR 1.34; p=0.009). Conclusion: Preemptive listings in Hispanic patients yield fewer kidney transplants, LDKTs, or preemptive transplants compared to Whites, and more readily culminate in dialysis initiation. The prognostic value of preemptive registration is thus incompletely realized in Hispanic transplant candidates. Coordinated efforts are needed to bolster capacity for self-advocacy in Hispanic patients while augmenting access to providers able to guide them through early kidney transplant evaluations.