Factors Affecting Wait Times in Living-Donor Kidney Transplant

Background: Living donor kidney transplant (LDKT) offers a life-saving option for patients with end stage kidney disease, reducing wait times compared to deceased donor transplants. However, the characteristics of candidates that wait a shorter period compared to those waiting longer is unclear. We stratified the cohort by duration of wait times for a LDKT to analyze characteristics. Methods: We included adult LDKT recipients at the University of Pennsylvania between 1/1/2015 and 11/30/2023. The wait time for a LDKT was defined as the time from the date of waitlisting to time of transplant. Patient characteristics were analyzed based on wait times of <1 year, 1-2 years, and >2 years. Pertinent factors determining wait times for a well-matched LDKT offer were presented in a multidimensional heatmap. Results: Candidates receiving directed donor LDKT experienced the shortest wait times across all height and blood type categories, whereas end-chain LDKT recipients had the longest wait times. Non-White candidates were more likely to wait >2 years. Most White candidates received LDKT within 1-2 years. Candidates with blood type B had longer wait times. Conclusion: Blood type and the source of LDKT impacted wait times the most. Minorities waited longer for a LDKT, highlighting disparities in access to LDKT. Future studies should explore mechanisms driving these disparities.1. Baseline Characteristics - < 1 year (N=249) 1-2 years (N=197) > 2 years (N=213) p-value Recipient Age 49 (15) 47 (13) 52 (12) 0.002 Recipient Female Gender 84 (33.7%) 84 (42.6%) 88 (41.3%) 0.1 Type of Transplant < 0.001 Directed Donor LDKT 202 (81.1%) 123 (62.4%) 102 (47.9%) End Chain LDKT 7 (2.8%) 11 (5.6%) 39 (18.3%) Paired Kidney Exchange LDKT 40 (16.1%) 63 (32.0%) 72 (33.8%) Recipient Race < 0.001 White 159 (80.7%) 202 (81.1%) 136 (63.8%) Non-White 34 (15.6%) 51 (22.4%) 77 (36.2%)