*Purpose: Disparities in access to kidney transplantation (KT) among non-White patients is well-known, especially as it relates to living donor kidney transplantation (LDKT). We investigated the impact of participation in a paired-donor exchange program and the receipt of end-of-chain donor allografts to the deceased donor kidney transplant waitlist as a means to improve access to LDKT for non-White candidates.

*Methods: We retrospectively reviewed all LDKT at our institution between January 1, 2017 and October 31, 2021 and national data using the Organ Procurement Transplant Network (OPTN) data sets. We compared rates of LDKT among patients identifying as non-White to determine if there were any significant differences from the cohort of patients identifying as White.

*Results: Between January 1, 2017 and October 31, 2021, 53 patients had an LDKT at our institution. Twenty-six of the 53 patients received an end-of-chain allograft. Of the 26 patients, 38.5% were Black; compared to 11.1% of the remaining 27 patients who had a planned LDKT (p=0.021). Further analysis revealed that the patients who received an end-of-chain allograft experienced shorter wait time for transplantation than those patients who had a planned LDKT, approximately 298 and 428 days, respectively (p=0.041). Review of OPTN data during this time period identified 18,888 patients who underwent LDKT with 12.3% of recipients identifying as Black. Compared to our institutional end-of-chain data this difference was statistically significant (p <0.001).

*Conclusions: Institutional participation in a paired-donor exchange program increased rates of LDKT for Black recipients with decreased average waiting times via receipt of end-of-chain donor allografts. This suggests that increased participation of transplant centers in kidney paired exchange programs could be a means to improve health disparities for Black patients with end-stage renal disease on the transplant waitlist.

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