Earlier studies reported inferior graft survival in black transplant recipients. We examined 20-year trends in outcomes to determine whether racial disparities improved over time. METHODS: Using SRTR data, we performed Cox proportional hazards models to compare all-cause graft loss among 145,489 white and 63,910 black adults who received a first-time live donor (LDKT) or deceased donor (DDKT) kidney transplant 01/01/1990 to 12/31/2012. We adjusted models for recipient, donor, and center factors, and we tested whether transplant year modified the association of recipient race with graft survival. RESULTS: There were greater improvements in 5-year graft loss after LDKT and DDKT among black recipients (15.2% and 20.8%, respectively) than white recipients (6.9% and 12.3%). (Fig 1) Differential improvements also translated into narrowed racial disparities. (Table 1)Blacks who received a DDKT during 1990-1992 were 39% more likely than whites to experience 5-year graft loss (aHR: 1.39, 95% CI: 1.31-1.47, p<0.001), while blacks who received a DDKT during 2007-2008 were only 10% more likely to experience 5-year graft loss than whites (aHR: 1.10, 95% CI: 1.03-1.18, p=0.006). Blacks who received a LDKT during 1990-1992 were 52% more likely than whites to experience 5-year graft loss (aHR: 1.52, 95% CI: 1.27-1.83, p<0.001), but this disparity was reduced by 14% for blacks who received a LDKT during 2007-2008 as compared with whites (aHR: 1.38, 95% CI: 1.17-1.62, p<0.001). By the end of the study period, there were no statistically significant racial differences in 1-year or 3-year graft loss after LDKT or DDKT. CONCLUSIONS: Our findings of dramatic improvements in racial disparities in transplant outcomes reinforce the need to improve access to kidney transplantation for black patients.

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