Genomic Insights into Kidney Transplant Candidate Evaluation: Implications for Wait-Listing

Background: Although a significant number of patients with chronic kidney disease (CKD) have underlying genetic causes, the role of genetic testing in guiding kidney transplant (KTx) candidate evaluation remains unclear. This study aimed to assess the impact of genetic testing with other demographic and clinical factors on waitlisting outcome in KTx candidates. Methods: A retrospective cohort of 268 patients with CKD evaluated for KTx between 2015 and 2024 was conducted. The primary outcome was waitlisting status. Variables analyzed included intended recipients age, sex, ancestry, family history or renal disease, etiology of CKD, age at diagnosis, and genetic testing results (positive or negative). Results: Of the 268 patients evaluated, 157 (59%) were waitlisted and 80 (30%) underwent kidney transplantation. The median follow-up period was 19.5 months (IQR 20-87 months). The average patient was 50.2 years old, with a male predominance (64%). Older age at assessment (p=0.003) and older age at diagnosis (p=0.044) were significantly associated with lower odds of waitlisting. Female sex was associated with a non-significant trend lower waitlisting rate (p=0.09). Ancestry was a significant predictor (p=0.04), with African American/Afro-Caribbean (57.1%) and European (34.0%) being the most represented groups. Genetic testing results, cause of CKD, and family history of kidney disease were not significantly associated with waitlisting outcomes (p>0.05). Conclusion: In this study, age and ancestry had a stronger role in waitlisting status than genetic testing results, family history or etiology of CKD. These results highlight the need for further studies on how demographic and socioeconomic factors influence access to transplant waitlisting and whether genetic insights are being underutilized in candidate evaluation.