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Kidney Week

Abstract: FR-PO792

Outcome of Organ Procurement and Transplantation Network (OPTN) Policy Allowing for Waiting Time Modification for Candidates Affected by Race-Inclusive eGFR Calculations: Early Impact from a Single Center

Session Information

Category: Diversity and Equity in Kidney Health

  • 900 Diversity and Equity in Kidney Health

Authors

  • Wekesa, Debra, University of Nebraska Medical Center, Omaha, Nebraska, United States
  • Westphal, Scott G., University of Nebraska Medical Center, Omaha, Nebraska, United States
  • Miles, Clifford D., University of Nebraska Medical Center, Omaha, Nebraska, United States
Background

Black patients have a high burden of kidney disease yet experience lower rates of waitlisting and kidney transplantation. There is a myriad of reasons for these disparities, including the historic race modifier used for GFR estimation, which ascribes a higher GFR at a given serum creatinine level in black individuals. Since eGFR ≤ 20 ml/min is required for waiting time accrual, the eGFR race modifier could delay listing for some black patients. In January 2023, the OPTN implemented a policy whereby registered black transplant candidates could receive waiting time adjustment if a prior race-inclusive eGFR calculation yielded values such that “non-African American” eGFR was ≤ 20 ml/min, but the “African American modified eGFR was >20 ml/min.

Methods

Upon enactment of this policy, our transplant program identified potential candidates, and through internal EMR review, communication with patients, their nephrologists, and PCPs, eligible candidates were identified for waiting time modification. Here, we report the impact of this policy change at a single center one month after submission for waiting time modification for eligible candidates.

Results

37 adult patients on our waitlist had self-identified as Black or African American. In 19 (51.4%) patients, historic race-inclusive GFR estimates were found that allowed for waiting time modification. In these patients, a mean 753 ± 788 and median 407 (327, 901) additional days of waiting time was added. The maximum time added for a single patient was 3,323 days (9.1 years). 4 of the 19 (21%) candidates received a deceased donor kidney transplant within 1 month of waiting time modification.

Conclusion

At a single center, >50% of patients were eligible for waiting time addition, with an average of >2 years of waiting time added per eligible candidate. Importantly, this modification yielded near immediate impact, with >20% of patients receiving a transplant within the first month of the modification. While the number of black patients on our waiting list is small relative to many centers, this early assessment of the policy impact demonstrates the potential of its intended effects. Centers with large numbers of black patients will require a coordinated effort to ensure timely identification and implementation of appropriate waiting time addition.