Racial disparities in preemptive referral for kidney transplantation in Georgia

Jennifer C. Gander, Xingyu Zhang, Laura Plantinga, Sudeshna Paul, Mohua Basu, Stephen O. Pastan, Eric Gibney, Erica Hartmann, Laura L Mulloy, Carlos F Zayas Montalvo, Rachel E. Patzer

Research output: Contribution to journalArticlepeer-review

54 Scopus citations


Background: Racial disparities persist in access to kidney transplantation. Racial differences in preemptive referral, or referral prior to dialysis start, may explain this discrepancy. Methods: Patient-level data on kidney transplant referrals (2005-2012) from all Georgia transplant centers were linked to the United States Renal Data System to examine racial disparities in preemptive referral, waitlisting, and living donor transplant. Adjusted logistic regression and Cox proportional hazard models determined the associations between race (African American vs white) and preemptive referral, and placement on the waitlist and receipt of a living donor kidney, respectively. Results: Among 7752 adults referred for transplant evaluation, 20.38% (n = 1580) were preemptively referred. The odds of African Americans being preemptively referred for transplant evaluation were 37% (OR = 0.63; [95% CI: 0.55 0.71]) lower than white patients. Among preemptively referred patients, there was no racial difference (African Americans compared to white patients. HR = 0.96; [95% CI: 0.88, 1.04]) in waitlisting. However, African Americans were 70% less likely than white patients to receive a living donor transplant (HR = 0.30; [95% CI: 0.21, 0.42]). Conclusion: Racial disparities in transplant receipt may be partially explained by disparities in preemptive referral. Interventions to reduce racial disparities in kidney transplant access may need to be targeted earlier in the disease process.

Original languageEnglish (US)
Article numbere13380
JournalClinical Transplantation
Issue number9
StatePublished - Sep 2018

ASJC Scopus subject areas

  • Transplantation


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