Racial/ethnic minorities have less access to preemptive live donor kidney transplantation (PLDKT) than whites. Our objective was to examine determinants of racial/ethnic disparities in PLDKTs in the US. METHODS: Using SRTR patient data linked with zip-code level US Census data, we performed multivariable logistic regression models to analyze associations of recipient race/ethnicity with receipt of a PLDKT among 57,286 adults who received a first-time live donor kidney transplant between January 1, 2003 and December 31, 2013. We estimated racial/ethnic differences in the degree of reduced access to PLDKTs due to clinical, socioeconomic (SES), and center-level factors, and we calculated bias-corrected confidence intervals using bootstrap analyses. RESULTS: Overall, 16,581 patients received a PLDKT. Blacks (aOR: 0.35, 95% CI: 0.33-0.38, p<0.001), Hispanics (aOR: 0.38, 95% CI: 0.36-0.41, p<0.001), and Asians (aOR: 0.54, 95% CI: 0.49-0.59, p<0.001) were less likely to receive a PLDKT than whites. The largest fraction (9.5% and 7.1%, respectively) of the disparity among Hispanics and blacks compared with whites was due to adjustment for SES factors. (Table 1) Adjustment for all clinical, SES, and center factors accounted for 21% and 11% of the disparity among Hispanics and blacks, but only 4% of the disparity among Asians. CONCLUSIONS: SES factors appear to play a greater role than clinical or center factors in contributing to disparities in access to preemptive LDKT for black and Hispanic recipients. Targeted efforts to address SES determinants of delays in LDKT may help mitigate disparities.

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