*Purpose: Disparities in access to living donor kidney transplantation (LDKT) exist among minorities and women and may be partially explained by antigen sensitization secondary to prior pregnancies, transplants or blood transfusions, creating difficulty finding compatible matches. To address these obstacles, an incompatible LDKT program, incorporating desensitization and kidney paired donation, was created at our institution.

*Methods: A retrospective cohort study was performed among our kidney transplant waitlist candidates (n=8895). Multivariable Cox regression was utilized, comparing likelihood of LDKT before (Era 1: 01/2007-01/2013) and after (Era 2: 01/2013-11/2018) implementation of the incompatible program. Candidates were stratified by race (white vs. minority (non-white)), gender, and breadth of sensitization.

*Results: Patient characteristics are shown in Table 1 (Table). Program implementation resulted in the nation’s longest single-center kidney chain, and likelihood of LDKT increased by 70% for whites (aHR 1.70; 95%CI: 1.46-1.99) and more than 200% for minorities (aHR 2.05; 95%CI: 1.60-2.62). Improvement in access to LDKT was greatest among sensitized minority women (Figure).

*Conclusions: Implementation of an incompatible program, and the resulting nation’s longest single-center kidney chain, mitigated disparities in access to LDKT among minorities, specifically sensitized women. Extrapolation of this success on a national level may further serve these vulnerable populations.

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