Abstract: FR-PO1006
New Equation for Equity: Race-Neutral eGFR and the Transplant Wait Times in Black Individuals
Session Information
- Transplantation: Clinical - Pretransplantation, Living Donation, and Policies
November 07, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2102 Transplantation: Clinical
Authors
- Bavi, Santhoshi Rupa, Boston Medical Center, Boston, Massachusetts, United States
- Ghai, Sandeep, Boston Medical Center, Boston, Massachusetts, United States
- Curreri, Karen A, Boston Medical Center, Boston, Massachusetts, United States
- Francis, Jean M., Boston Medical Center, Boston, Massachusetts, United States
Background
Race, a social construct, may drive disparities in kidney transplant access for Black patients. The Black population already faces a higher burden of CKD and ESRD, with ESRD prevalence nearly four times that of non-Hispanic White individuals. Furthermore, the race coefficient in eGFR equations like MDRD inflated GFR by 15–20% in Black patients, delaying transplant eligibility, and placing them at a disadvantage due to higher dialysis-related mortality and missed survival benefits of preemptive transplantation. To address these healthcare inequities, ASN and NKF in September 2021 recommended removing the race coefficient from eGFR calculations. In January 2023, OPTN followed with a policy mandating transplant centers to identify Black candidates affected by race-based eGFR and adjust their waiting times accordingly. We aim to analyze the early impact of this policy change on the transplant wait times for the Black population at a safety net hospital.
Methods
Beginning in March 2023, the kidney transplant program at Boston Medical Center reviewed all listed Black candidates and identified those eligible for wait time adjustments. Eligible candidates received wait time modification after submission of supporting documentation to UNOS. We analyzed the impact of this policy change on wait times and transplant activity from March 2023 to January 2025.
Results
Assessment of 163 self-identified Black adults on our waitlist revealed that 92 (56.4%) candidates were eligible for additional wait time, with a median gain of 20.7 months. The duration of wait time gained varied from a minimum of 14 days to a maximum of 12.9 years. 43.4% gained at least 2 years, and 19.5% gained at least 4 years of wait time. Of the candidates who gained wait time, 19 (20.6%) underwent transplantation during the study period. 11 of these 19 candidates received transplantation within a year of modification of wait time, while one was a pre-emptive transplantation.
Conclusion
Early findings from our center indicate that the wait time modification policy based on race-neutral eGFR may meaningfully reduce racial disparities in access to kidney transplantation for Black individuals. Further data analysis will be needed in the coming years to investigate the applicability of our findings to other centers.