Evaluation Of Living Donors Research Articles

A Comparison of Close Family Members and Other Relationships in Live Kidney Donor Evaluation

A Comparison of Close Family Members and Other Relationships in Live Kidney Donor Evaluation

A Single-Center Retrospective Study to Identify Causes of Sex Differences in the Living Kidney Donor Evaluation Process.

Multiple studies have shown that females are living donors for kidney transplantation at higher rates than males. However, the underlying reasons for this observation are not well-understood. We examined the living donor evaluation process to determine the point at which sex imbalance arises. Based on a previous study, we hypothesized that both sexes are equally likely to become approved as living donors, but females are more likely to follow through with donation. Single institution retrospective chart review of self-referrals for living donor evaluation between 1/2009 - 12/2022. Self-referrals identified using the Organ Transplant Tracking Record database and cross referenced with billing data. Exclusion at each stage of evaluation was recorded and compared between sexes using log binomial regression; unadjusted and adjusted (for donor age, race, ethnicity, relationship to recipient, and recipient sex) risk ratios (RRs) with 95% confidence interval (CI) were determined. 1,861 self-referrals were reviewed, including 1,214 (65.2%) females and 647 (34.8%) males, resulting in 146 approvals and 125 donations (76/125, 60.8% females, 49/125 39.2% males). Adjusted RRs indicated no significant differences between sexes in completing medical and/or psychosocial workup, having medical and/or psychosocial contraindications, being approved for donation, and proceeding with donation. The top medical contraindications for both sexes were obesity, hypertension, and nephrolithiasis. Female overrepresentation among living donors is likely due to the 1.9 times higher rate of self-referral for evaluation. After this point, both sexes were equally likely to complete workup, be approved, and follow through with donation. Increased efforts to engage males at the initial self-referral stage has the potential to expand access to living donor kidney transplantation.

301.7: Vibration-controlled transient elastography as a non-invasive tool to exclude hepatic steatosis in living liver donor evaluation.

301.7: Vibration-controlled transient elastography as a non-invasive tool to exclude hepatic steatosis in living liver donor evaluation.

The Medical Costs of Determining Eligibility and Waiting for a Kidney Transplantation.

Recent efforts to increase access to kidney transplant (KTx) in the United States include increasing referrals to transplant programs, leading to more pretransplant services. Transplant programs reconcile the costs of these services through the Organ Acquisition Cost Center (OACC). The aim of this study was to determine the costs associated with pretransplant services by applying microeconomic methods to OACC costs reported by transplant hospitals. For all US adult kidney transplant hospitals from 2013 through 2018 (n=193), we crosslinked the total OACC costs (at the hospital-fiscal year level) to proxy measures of volumes of pretransplant services. We used a multiple-output cost function, regressing total OACC costs against proxy measures for volumes of pretransplant services and adjusting for patient characteristics, to calculate the marginal cost of each pretransplant service. Over 1015 adult hospital-years, median OACC costs attributable to the pretransplant services were $5 million. Marginal costs for the pretransplant services were: initial transplant evaluation, $9k per waitlist addition; waitlist management, $2k per patient-year on the waitlist; deceased donor offer management, $1k per offer; living donor evaluation, procurement and follow-up: $26k per living donor. Longer time on dialysis among patients added to the waitlist was associated with higher OACC costs at the transplant hospital. To achieve the policy goals of more access to KTx, sufficient funding is needed to support the increase in volume of pretransplant services. Future studies should assess the relative value of each service and explore ways to enhance efficiency.

Improving value delivery in living donor kidney transplant through process improvement.

Living donor kidney evaluation has substantial time variations with significant intercenter variation. One-day donor evaluation has shown to be clinically efficient and improve transplant rates. However, patients' perception of 1-day evaluation is unknown. We hypothesized that 1 day LKD evaluation will improve patient satisfaction and improve living donation rates. All interested LD candidates from April 2018 to May 2020 were enrolled in the study. Non-directed donors, donors greater than 60 years old, and recipients with more than three donors underwent multi-day evaluation (control group) while the rest underwent 1-day evaluation (intervention group). An anonymous survey was filled by both groups to assess their perceptions on different areas including time, communication, experience, information provided, and their preferences on living donor evaluation. Donor candidates in the 1-day evaluation group selected that the time from the questionnaire to clinic evaluation took "under 1 month" or "less than 3 months" (62.5%vs. 15.8%, p=.002), with "excellent" for both scheduling process (65%vs. 31.6%, p=.03) and communication (82.5%vs. 57.9%, p=.09) when compared to candidates in the multiple-days evaluation group. One-day candidates felt "very satisfied" with the overall experience (95%vs. 68.4%, p=.02) and felt "extremely well" with the information provided regarding the living donor process (87.5%vs. 47.4%, p=.003) when compared to multiple-day evaluation group. Regardless of the group, 53 (89.8%) patients preferred 1-day evaluation. We demonstrate 1-day living donor evaluation is efficient, patient preferred, and adds value through improved communication, and better overall patient satisfaction.

Incidental findings during donor liver assessment: Single center experience

Intraoperative consultation of donor liver is an important part of transplant evaluation and determination of liver eligibility. In this study, we describe incidental pathologic findings discovered during the pretransplant evaluation of liver donors in our Institution from 1/2010 to 12/2022. During this 13-year period 369 intraoperative consultations from 262 liver donors were performed. Of those cases, incidental findings were identified in 22 cases (5.9 %) from 19 donors (7.3 %); two donors had more than one lesion. The median age of this subset of patients was 53 years (range: 18–70) and females predominated (63 %). Sixteen of the donors had abnormal findings in the liver: 6 bile duct hamartoma (BDH), 5 hyalinized nodule with Histoplasma capsulatum, 5 focal nodular hyperplasia (FNH), 2 bile duct adenomas (BDA), 1 biliary cyst and 1 hemangioma. One donor had both FNH and a BDH. One BDH and 1 BDA case was misdiagnosed as malignancy during the frozen section evaluation. Three donors had extrahepatic pathologies: a pancreatic tail schwannoma, a low-grade appendiceal mucinous neoplasm, and a lymph node with metastatic endometrial endometrioid adenocarcinoma. Of the 19 livers, the final organ disposition was available for 9: 6 were transplanted (67 %) and 3 were discarded (33 %). Two of the 3 discarded organs were misdiagnosed BDH and BDA cases, and one was incorrectly reported as having 90 % microvesicular steatosis during the frozen assessment. We present the clinicopathologic characteristics of liver donors with incidental findings during the pre-transplant evaluation which could lead to unwarranted graft dismissal if misdiagnosed. Additionally, incidental fungal infections can have implications for immunosuppressive therapy and the decision to use or reject the graft.

Multiphasic MDCT of Living Renal Donors, Prior to Surgery

Background: Live kidney donor evaluation mandates anatomical and functional assessment of the donor kidney. Multiphasic Multidetector computed tomography (MDCT) with advanced 3‐D techniques provides a detailed description of the vascular, parenchymal, and collecting system. Objectives: To evaluate the clinical application of Multiphasic MDCT in the pre-operative anatomic assessment of prospective donor kidneys. Methods: Multiphasic MDCT was performed in thirty-eight patients as part of a pre-operative assessment. Each study comprised three phases of imaging, including the arterial, venous, and excretory phases. Results: The predominant radiological finding amongst the cases studied was that of the presence of accessory renal arteries in 35% of the patients. Multiphasic MDT was also able to detect renal parenchymal disease in one case. Post-renal anatomical evaluation also identified renal calculi in 12.5% of the total cases. Conclusions: There is considerable scope for multiphasic MDCT in the pre-operative evaluation of donor kidneys, especially as modern-day renal transplant surgery sees a shift towards laparoscopic techniques where intraoperative anatomic evaluation can be restricted. The multiphasic MDCT is useful in pre-renal, renal, and post-renal anatomic evaluation. Advances in Knowledge: Multiphasic MDCT can provide noninvasive, detailed, and fast images to aid the preoperative evaluation of donor kidneys.

Non-Contrast Enhanced Magnetic Resonance Venography Using the Fast Imaging Employing Steady-State Acquisition (FIESTA) Pulse Sequence in Preoperative Evaluation of Liver Donors: Can it Replace CT Venography?

Background: Liver transplantation has now become the preferred treatment for patients with liver failure. Pre-operative assessment of hepatic/portal vein anatomy of donors is necessary for which CT venography is most commonly used but it exposes the donors to huge radiation burden. To avoid this, non-contrast MR venography is the most preferred alternative for evaluation of veins. Objective: To determine diagnostic yield of magnetic resonance venography using Fast Imaging Employing Steady-State Acquisition (FIESTA) pulse sequence in comparison to computed tomography venography for the determination of portal/hepatic venous anatomy of potential liver donors. Methods: Retrospective study was conducted in which the venous phase CT scan and FIESTA (b-SSFP) sequence of 50 potential liver donors between 01-07-2021 and 30-11-2021 were reviewed. The hepatic and portal venous anatomy was reviewed. The assessment comprised the type of portal venous anatomy, the number of prominent tributaries from segment VIII and V of liver having diameter of 4mm or more emptying into the middle hepatic vein and the total number of accessory inferior right hepatic veins from segment VI and VII emptying into inferior vena cava (IVC). Results: With 100% sensitivity and specificity, the FIESTA sequence precisely identified the portal vein anatomy, total number of accessory inferior right hepatic veins, and the total number of 4 mm thick tributaries from segment V and VIII draining into middle hepatic vein Conclusion: We propose that magnetic resonance venography using FIESTA sequence can be used instead of CT venography to determine hepatic and portal vein anatomy of liver donors.

Implementation of a culturally competent APOL1 genetic testing programme into living donor evaluation: A two-site, non-randomised, pre–post trial design

IntroductionWhile living donor (LD) kidney transplantation is the optimal treatment for patients with kidney failure, LDs assume a higher risk of future kidney failure themselves. LDs of African ancestry have...

Vibration Controlled Transient Elastography to Evaluate Steatosis in Candidate Living Donors for Liver Transplantation.

The ability of vibration controlled transient elastography (VCTE) to reliably exclude significant steatosis in living donor candidates could obviate the need for invasive liver biopsies, expedite the donor approval process, and reduce recipient wait time. We therefore aimed to determine whether VCTE controlled attenuation parameter (CAP) could be used to detect steatosis in potential living donors. Living donor candidates who presented for evaluation between 2016 and 2019 underwent standard donor workup, VCTE, and liver biopsy if indicated. CAP scores were compared with MRI-Fat Fraction and, when available, histologic fat fraction from liver biopsy. Receiver operating characteristic curves were used to identify cutoffs with appropriate sensitivity and specificity for screening. Statistical analysis was conducted using R (version 3.6.0). Seventy-nine candidate living donors presented during the study period, of whom 71 were included in the final analysis and of whom 20 underwent liver biopsy. There was a positive correlation between MRI-Fat Fraction and CAP scores with an observed Spearman correlation coefficient of 0.424 ( P < 0.01). A CAP score of 271.5 dB/m or less was determined to have 89.8% sensitivity and 75% specificity for detecting <5% steatosis on MRI. The correlation between CAP and steatosis of available histologic samples had a Pearson correlation coefficient of 0.603 ( P = 0.005). A CAP cutoff of 276.0 dB/m demonstrated 66.7% sensitivity and 85.7% specificity for detecting <15% histopathologic steatosis and positive and negative predictive values of 71.5% and 82.7%, respectively. VCTE can be integrated into living donor evaluation to accurately screen for hepatic steatosis.

The living donor evaluation as a life‐saving event

As a population, living kidney donors have a longer life expectancy than the general population. This is generally thought to be an artifact of selection, as only healthy individuals are allowed to donate, and the operative mortality and risk of subsequent renal failure are very low. However, there may also be an additional benefit to the process, as the donor evaluation may uncover an early occult cancer or a potentially serious medical problem. While these problems may preclude donation, they may be lifesaving, as they are likely to be diagnosed and treated before the donor develops symptoms. We looked at the incidence of occult cancer and other previously undiagnosed medical problems including renal disease, diabetes, hypertension, cardiac disease, and hepatitis C, in individuals volunteering to become a kidney donor at our center who proceeded with the evaluation between January 1, 1996 and May 31, 2011. Of 4088 potential donors, 19 (.46%) were discovered to have an unsuspected cancer, and 286 (7%) were found to have a previously undiagnosed medical problem. The living donor evaluation may lead to the early diagnosis of a life-threatening illness. This should be considered as one of the potential benefits of living donation.

The (perhaps not-so-) hidden benefit of the living donor evaluation.

The (perhaps not-so-) hidden benefit of the living donor evaluation.

Predictors of hepatic steatosis in living liver donors

Fatty liver disease (steatosis) is considered a risk factor in donor liver transplantation (LT). Macrosteatosis (&gt;50%) is associated with primary graft dysfunction and may reduce long-term recipient survival.Objective: to identify predictors of macrovesicular steatosis (&gt;50%) by analyzing donor characteristics.Materials and methods. The retrospective study included 525 potential liver donors between January 1, 2019 and December 31, 2020. Clinical and morphological characteristics of donors were studied using logistic regression and receiver operating characteristic (ROC) analysis. Threshold values of parameters demonstrating statistical significance in multivariate analysis as predictors of &gt;50% hepatic steatosis were obtained by ROC analysis based on calculation of the optimal cutoff point.Results. Diabetes mellitus (DM), cause of donor’s death (traumatic brain injury), alanine transaminase (ALT) &gt;90 units/L and aspartate transaminase (AST) &gt;110 units/L were predictors of &gt;50% steatosis, revealed by time-zero biopsy in the donor. Almost identical sensitivity and specificity indicators were determined in ROC analysis for liver enzymes – ALT and AST – which were 69.1 and 80.6; 72.2 and 81.1, respectively. Given the obtained values, we can say that with elevated levels of liver enzymes in the donor’s blood, there is a high degree of probability of liver parenchymal damage, but low sensitivity indicates possible multifactoriality of liver damage, and fatty liver disease may be one of the factors, but there may also be no damage to the liver parenchyma. At the same time, the rather high specificity revealed in ROC analysis for liver enzymes is a reliable sign of the absence of fatty liver disease at enzyme values less than the threshold.Conclusion. The thresholds established for ALT and AST and their corresponding levels of sensitivity and specificity indicate that these parameters have a relatively low predictive level in the context of the presence of severe fatty liver disease in a donor. This allows, nevertheless, to use models built on their basis as screening models in the primary evaluation of liver donors.

Optimizing pre-donation physiologic evaluation for enhanced recovery after living liver donation - Systematic review and multidisciplinary expert panel recommendations.

While preoperative physiologic evaluation of live liver donors is routinely performed to ensure donor safety and minimize complications, the optimal approach to this evaluation is unknown. We aim to identify predonation physiologic evaluation strategies to improve postoperative short-term outcomes, enhance donor's recovery, and reduce length of stay. We also aim to provide multidisciplinary expert panel recommendations. Ovid MEDLINE, Embase, Scopus, Google Scholar, and Cochrane Central. The systematic review followed PRISMA guidelines, and the recommendations were formulated using GRADE approach and experts' opinion. The search included retrospective or prospective studies, describing outcomes of physiologic evaluation predonation. The outcomes of interest were length of stay, postoperative complications (POC), recovery after donation, and mortality. PROSERO protocol ID CRD42021260662. Of 1386 articles screened, only three retrospective cohort studies met eligibility criteria. Two studies demonstrated no impact of age (<70 years) on POC. Increased body mass index's (BMI) association with POC was present in one study (23.8vs 21.7kg/m2 , OR 1.67 (1.14-2.48), P=.01) and absent in another (<30vs 30-35kg/m2 , P=.61). One study demonstrated decreased risk for postdonation subclinical hepatic dysfunction in donors with higher normal platelet count (PLT). None of the studies noted donor death. Given the scarce data on predonation physiologic testing, the expert panel recommended a battery of tests to guide clinical practice and future investigations. Advancing age (60-69 years) is not a contraindication for liver donation. There is insufficient evidence for a specific predonation BMI cut-off. Abbreviated predonation physiologic testing is recommended in all candidates. Comprehensive testing is recommended in high-risk candidates while considering the pretest probability in various populations (Quality of evidence; Low to Very Low | Grade of Recommendation; Strong).

423.1: Characteristics and Long-term Outcomes of Female Kidney Donors

Introduction: Almost twice as many females donated a kidney in the United States between 1988-2021. Yet, detailed information regarding their long-term outcomes are sparse. Importantly, there has been no studies that addressed the possible contribution of pregnancy or gestational complications. Therefore, we compared mortality, cardiovascular disease (CVD), and development of hypertension, diabetes, proteinuria, reduced estimated glomerular filtration rate (eGFR) and kidney failure in 4,995 females and 3881 male donors. Methods: We studied female donors in a retrospective cohort study of kidney donors who donated between 1963 to 2007 at three US transplant centers as a part of The Renal and Lung Living Donor Evaluation Study. Mortality, CVD, diabetes, hypertension, proteinuria and reduced eGFR for the entire cohort and for females after adjusting for pregnancy and gestational complications were studied using multivariable analysis. Results: At 17.4±10.8 years after donation, 4.1% of female donors and 5.8% of male donors were deceased, aHR 0.53 (95% CI 0.37, 0.76), p = 0.001; 6.5% vs. 8.0% developed diabetes, aHR 0.98 (95% CI 0.71, 1.32), p = 0.88; and 32.5% vs. 42.5% developed hypertension, aHR 0.87 (95% CI 0.77, 0.97), p = 0.02. The multivariable risks of death, CVD and hypertension were higher in male donors. The risk of reduced eGFR, proteinuria and ESKD were, however, comparable in both sexes. A similar proportion of female and male donors developed eGFR < 30 mL/min/1.73m2 or kidney failure; 1.6% vs. 1.9%, aHR 0.68 (95% CI 0.34, 1.35), p = 0.98 (Figure 1, Figure 2). Donors with pregnancies prior to donation and gestational complications (compared to nulliparous donors) were at increased risk for this composite outcome; aHR 4.02 (95% CI 1.24, 13.02), p=0.02 and aHR 6.06 (95% CI 1.59, 23.15), p= 0.01, respectively.Conclusions: These results demonstrate that the overall risk of kidney failure is similar in female and male kidney donors. Pre-donation pregnancies and gestational complications were associated with a 4- to 6-fold increased risk of eGFR <30 mL/min/1.73m2 or ESKD compared to those without prior pregnancies. Our results are at odds with these previous studies that stated that males are at an increased risk of CVD and faster progression to ESKD. We believe the difference may stem from accounting not only for post-donation events such as diabetes and hypertension but also for prior pregnancies and gestational complications.

Living and Deceased Liver Donation Criteria of Baskent University.

Both living and deceased donor transplants require appropriate donor selection to increase the success of liver transplants. Proper deceased donor criteria will also increase the use of discarded and marginal donor livers. Here, we evaluated the Baskent University deceased and living donor criteria. Since 1988, our team has performed 704 liver transplants (490 from living [69.6&] and 214 from deceased [30.4&] donors) at our 3 transplant centers (Ankara, Adana, Istanbul). Living donor evaluations follow from simple and noninvasive tests to more complex and invasive, including liver biopsy, with social and medical evaluations being the most important. Living donor candidates must be relatives of the recipient (up to 4th degree) or the spouse of the recipient, and candidates must be ≥18 years old, with no health problems. Candidates undergo computed tomography to assess arterial and venous anatomy, to estimate total and remnant liver volume, and to detect any abnormalities. If graft-to-recipient weight ratio is >1 and remnant liver volume is ≥40% of total liver volume, then the candidate is accepted for further evaluation. All living donor candidates undergo liver biopsy. Age is not important for deceased donor candidates, but biopsy is the most important criterion in deceased donor selection. After histopathological examination, both living and deceased donor candidates are rejected if they have chronic hepatitis, cirrhosis, severe hepatocellular injury, diffuse hepatocellular ballooning, or moderate-to-severe macrovesicular fatty changes >20%. Additional refusal criteria for deceased donors are hypernatremia, sepsis, extracranial malignancy, and high-dose vasopressor support. A deceased donor is the first choice in organ transplant. Proper evaluations can decrease discard rates of deceased organs. Living donor liver transplants should be performed only at well-established centers with surgical teams who have appropriate medical expertise and adequate institutional resources. To reduce complications and provide adequately functional grafts, careful donor evaluation is imperative.

Telehealth Use by Living Kidney Donor Transplant Programs During the COVID-19 Pandemic and Beyond: a Practical Approach.

Purpose of ReviewCOVID-19 pandemic led to a decline in living kidney donor evaluations and transplants. This was due to concerns for donor and recipient safety, restrictions on elective cases, and diversion of staff and resources in centers with a higher incidence of COVID-19 infections. Telehealth was explored as a strategy to continue living donor evaluations during the pandemic, but faced barriers including restrictive physician licensing, reduced reimbursement, lack of infrastructure, prohibitive local policies, limited exam, and personal biases. This review highlights these barriers and potential solutions.Recent FindingsTelehealth usage in the transplant population improves medication adherence, reduces hospitalization rates for recipients, and makes living donor evaluation convenient. Transplant centers have implemented telehealth successfully for living kidney donor evaluations. Broad use of telemedicine will be possible only if policies support the changing landscape of healthcare delivery.SummaryTelehealth may increase access to timely kidney transplants by expediting living kidney donor evaluations. However, supportive infrastructure, regulatory policies, and reimbursement are needed to sustain access to telehealth for living kidney donor evaluation and care.

Circuitous Path to Live Donor Liver Transplantation from the Coordinator's Perspective.

Background: The live donor liver transplantation (LDLT) process is circuitous and requires a considerable amount of coordination and matching in multiple aspects that the literature does not completely address. From the coordinators’ perspective, we systematically analyzed the time and risk factors associated with interruptions in the LDLT process. Methods: In this retrospective single center study, we reviewed the medical records of wait-listed hospitalized patients and potential live donors who arrived for evaluation. We analyzed several characteristics of transplant candidates, including landmark time points of accompanied live donation evaluation processes, time of eventual LDLT, and root causes of not implementing LDLT. Results: From January 2014 to January 2021, 417 patients (342 adults and 75 pediatric patients) were enrolled, of which 331 (79.4%) patients completed the live donor evaluation process, and 205 (49.2%) received LDLT. The median time from being wait-listed to the appearance of a potential live donor was 19.0 (interquartile range 4.0–58.0) days, and the median time from the appearance of the donor to an LDLT or a deceased donor liver transplantation was 68.0 (28.0–188.0) days. The 1-year mortality rate for patients on the waiting list was 34.3%. Presence of hepatitis B virus, encephalopathy, and hypertension as well as increased total bilirubin were risk factors associated with not implementing LDLT, and biliary atresia was a positive predictor. The primary barriers to LDLT were a patient’s critical illness, donor’s physical conditions, motivation for live donation, and stable condition while on the waiting list. Conclusions: Transplant candidates with potential live liver donors do not necessarily receive LDLT. The process requires time, and the most common reason for LDLT failure was critical diseases. Aggressive medical support and tailored management policies for these transplantable patients might help reduce their loss during the process.

Racial/ethnic and prior willingness disparities in potential living kidney donors\u2019 self-assessed responses to advancing American kidney health regulation

BackgroundRacial/ethnic disparities in living donor kidney transplantation (LDKT) are large, and rates of LDKT may be limited by indirect costs of living donation. A 2019 Executive Order– Advancing American Kidney Health (AAKH)– sought to remove indirect costs through an expanded reimbursement program. We examine how potential living kidney donors in the U.S. believe regulation stemming from the AAKH initiative will impact their living donor evaluation likelihood, how these beliefs vary by minority race/ethnicity and prior willingness to be evaluated, and how differences are explained by ability to benefit or knowledge and attitudes.MethodsData from a 2019 online survey (Families of Renal Patients Survey) were used. Respondents are U.S. adult (> 18 years) members of the Qualtrics Survey Panel who reported having relatives with weak or failing kidneys (N = 590). Respondents’ likelihood to be evaluated for living kidney donation are measured by self-report. Prior willingness is measured by past donation-related actions and current attitudes. Ability to benefit is measured by self-reported labor force participation and financial strain. Transplant knowledge is measured by self-report and a knowledge test, and transplant-related attitudes are measured by self-report. Average marginal effects of minority race/ethnicity and prior willingness for response to each provision in fully-adjusted models were estimated. Formal tests of mediation were conducted using the Karlson, Holm, and Breen (KHB) mediation model. Stata/MP 14.2 was used to conduct all analyses.ResultsMajorities of all groups report favorable responses to the provisions stipulated in AAKH regulation. Responses to provisions are significantly associated with race/ethnicity and prior willingness, with racial/ethnic minorities and those not previously willing to be evaluated less likely to report favorable responses to these provisions. Prior willingness differences are partially explained by group differences in ability to benefit and transplant-related knowledge and attitudes, but racial/ethnic differences largely are not.ConclusionsRegulation stemming from the AAKH initiative is likely to effectively promote LDKT, but may also exacerbate racial/ethnic disparities. Therefore, the regulation may need to be supplemented by efforts to address non-financial obstacles to LDKT in racial/ethnic minority communities in order to ensure equitable increases in LDKT rates and living donor support.

Removal of the Black race coefficient from the estimated glomerular filtration equation improves transplant eligibility for Black patients at a single center.

Race is a social construct that cannot be measured, can be used imprecisely and may contribute to disparities in kidney transplant access for Black patients. At Beth Israel Deaconess Medical Center, we dropped the Black race coefficient in the estimated glomerular filtration rate (eGFR) report in 2017. We conducted a quality improvement project to examine the impact of this change. Before the change, only 26% of our Black patients were listed for preemptive transplant compared to 70% of White patients. Since the change, we found a steady increase in the percentage of Black patients listed before starting dialysis. The average eGFR at listing prior to 2017 was significantly lower in Black patients but after, there was no longer a significant difference. Nine patients "gained" an average of 457 days of wait time directly related to discarding the Black race coefficient. Increased time on the list prior to dialysis initiation allows for evaluation of potential live donors and improves the possibility of a pre-emptive live or deceased donor transplant and allows for a shorter period on dialysis before transplant. In this single center initiative, we demonstrate the benefit of discarding race from the eGFR report for Black patients awaiting kidney transplantation.