*Purpose: In July of 2016, Minnesota became the second state in the nation to provide coverage for kidney transplantation to patients, regardless of immigration status, with Emergency Medical Assistance (EMA). Our aim is to discuss the outcomes at our transplant center of EMA patients that have received kidney transplants, characteristics of referred patients that went on to be listed for kidney transplant, and detail the unique challenges faced by this patient group including: fear of tracking recipients or living donors on a registry, pre-transplant workup not covered by EMA (i.e. dental), and difficulties maintaining active insurance coverage.

*Methods: A retrospective chart review of patients with ESRD, EMA, and referred to our center were identified in our prospectively maintained database. Our transplant center database was reviewed which included reasons patients were not listed; timing of referral, listing, and transplant; and additional workup needed and completed. Additional factors associated with comorbid conditions and surgical outcomes were reviewed in our electronic medical record. This study was approved by our Institutional Review Board for Human Subjects Research.

*Results: Since 2016, 76 EMA patients have been referred to our center for kidney transplant evaluation: 5 have been transplanted, 13 patients are currently listed (4 are listed hold), and 29 patients are referred. 29 patients are inactive, in large part, due to either loss of insurance coverage or unresolved medical issues. The 5 patients transplanted were on hemodialysis for an average of 11.7 (SD 5.5) years. The average age at transplant was 45.6 years and 3 of the patients were female. All received deceased donor kidneys (1 DCD and 4 DBD). The average KDPI was 15 (SD 20.7). The average GFR was 62, 72, 67, and 63ml/min at 3, 6, 9, and 12 months, respectively (1 patient is not yet 12 months post-transplant). One patient had delayed graft function and that same patient required re-operation for ureteral anastomosis disruption. No patients have suffered graft loss, and none have been lost to follow-up.

*Conclusions: This study highlights our institutions early experience transplanting patients with EMA. Our transplanted EMA patients have not experienced any unusual post-operative events, have acceptable kidney function, and have not been lost to follow up or had lapses in insurance coverage. However, despite legislation providing coverage, there are still numerous barriers these patients face in obtaining a kidney transplant.

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