Background It has been reported that African-Americans (AA) living kidney donors have an increased risk of ESRD versus non-Hispanic whites (NHW). To date, it is unknown to what degree these reports have influenced the living donor (LD) selection process for AA LD volunteers. We wished to determine whether selection stringency varied by race and age for prospective living kidney donors (pLKDs) at a transplant center serving a large AA community. Methods We conducted a retrospective intention-to-treat study to examine the outcome of living donor selection at a high-volume kidney transplant (KTx) center. The outcome of all donor referrals (Active, Deferred, or Ineligible) was compared between AA and NHW pLKDs. Results Between January and October 2016, 949 pLKDs contacted the transplant center [71% NHW, 18% AA, 11% other]. On average, fewer AA pLKDs volunteered per recipient candidate than NHW [1.3 pLKDs per newly listed AA KTx candidate vs. 3.4 pLKDs per newly listed NHW KTx candidate]. Despite fewer initial donor referrals, there was no difference in the frequency of AA and NHW pLKDs that achieved Active status at the end of the living donor evaluation [35% AA vs. 42% NHW; p = 0.08]. Attrition according to evaluation phase was also similar for both groups [22% of AA and NHW pLKDs were deemed ineligible after review of the initial screening questionnaire; 4% were deemed ineligible after subsequent review by the selection committee]. However, when we considered pLKD outcome by age group, we found that only 16% of AA pLKDs <25 years of age achieved Active status compared to 45% of NHW pLKDs in the same age range (p=.03). Notably, there was an increased prevalence of perceived predisposition to kidney disease in young AA pLKDs compared to NHW pLKDs (25% vs. 10%, respectively), although this did not reach statistical significance given the small size of the cohort (p=0.3). Conclusions Selection stringency for AA and NHW candidates appears to be uniform given that AA pLKDs achieve Active status as frequently as NHW. However, provider concerns regarding predisposition to kidney disease in younger AA candidates may increase the likelihood of ineligibility for prospective donors in this age group. While these concerns may be justified, this provider behavior is likely to exacerbate existing racial disparity in living donor kidney transplantation.

CITATION INFORMATION: Bohorquez D, Thomasson A, Porrett P. Impact of Race on Selection of the Living Donor Candidate. Am J Transplant. 2017;17 (suppl 3).

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