The number of live donor kidney transplants (LDKT) per year declined slightly in recent years, from 5,477 in 2004 to 4,655 in 2012 (15% decline). However, in the context of a growing deceased donor (DDKT) waitlist, changes in individual access to LDKT have not been described.

METHODS: Using SRTR data, we calculated the proportion of combined first-time adult DDKT waitlist registrants and LDKT recipients ("LDKT-eligible") 1991-2011 who received LDKT within two years of eligibility (the earlier of registration date or DDKT registration) over time. We used multilevel logistic regression to analyze patient characteristics associated with access to LDKT, accounting for center-level variation in LDKT rates.

RESULTS: LDKT access peaked at 24.1% of LDKT-eligible in 2003, then declined to 15.1% in 2011, a 37% decline (Figure 1). African-American (AA) patients had 65% lower odds of LKDT than non-AA patients (OR=_0.34 0.35 _0.36, p<0.001); Hispanic patients, older patients, and women also had less access to LDKT (Table 1). Adjusting for candidate characteristics and center-level effects, odds of LDKT declined 6% per year from 2003-2011 (OR=_0.93 0.94 _0.94, p<0.001, Table 1). The decline was steeper for AA patients (OR=_0.90 0.92 _0.93, interaction p<0.001, Figure 2) and less steep for college-educated non-AAs (OR=_0.94 0.96 _0.97, interaction p=0.01). If the 2003-2011 decline had not occurred, 2011 LDKT registrants would have received an estimated 4040 additional LDKT by 2013.

CONCLUSIONS: AA patients face greatly reduced access to LDKT. Access to LDKT declined dramatically since 2003. The decline was steeper for AAs and less steep for the college-educated.

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