*Purpose: Given recent attention on the impact of the race coefficient in equations for estimated glomerular filtration rate (eGFR) on racial disparities in kidney transplantation, we explored trends in preemptive listing for kidney transplantation over time and likelihood of receiving a preemptive transplant, adjusting for eGFR at listing as reported and after computationally removing the race coefficient.

*Methods: National registry study of all candidates added to the kidney transplant waiting list from 2001-2019. We calculated the proportion of candidates added to the waitlist preemptively over time, by binary race (Black, non-Black) and age. For Black candidates, we computationally removed the race correction from the reported eGFR by dividing by 1.16. Among preemptively listed candidates who did not receive a living donor transplant, we calculated the odds of receiving a preemptive deceased donor transplant vs. all other outcomes as of 12/31/2019 by race, controlling for cause of kidney disease and listing eGFR (as reported and with the correction computationally removed).

*Results: Among 511,712 candidates added to the kidney transplant waitlist in the United States from 2001-2019, 143,264 (28%) were added preemptively, with increasing frequency of preemptive listing over time and disparities observed by race and by age group (Figure 1). In 2019, 38% of non-Black candidates were listed preemptively with a median (interquartile range) eGFR of 15.4 mL/min (12.0-18.0) and only 21% of Black candidates were listed preemptively (median reported eGFR: 15.0 [11.6-18.0], with correction removed: 12.9 [9.5-14.7]). Black candidates had significantly lower odds of receiving a preemptive transplant, even after controlling for listing eGFR (odds ratio: 0.73, 95% confidence interval: 0.69-0.77) and eGFR with the race correction removed (0.82 [0.77-0.87], Figure 2).

*Conclusions: Racial disparities in access to preemptive kidney transplantation persist over time, even after computationally removing the race correction in reported eGFR, underscoring the need to identify and remove additional barriers in access to transplantation.

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