*Purpose: Graft failure is likely increasing among kidney transplant (KT) recipients due to improvements in patient survival. While the benefits of re-KT have been well documented, there are likely disparities in access to re-KT; we quantified the trends and disparities in access to re-KT.

*Methods: Using USRDS data, we identified 93,014 adult patients whose first KT graft failed between 1995-2017. We examined trends in graft failure over time and outcomes after graft failure by age, sex, and race. We estimated the chance of listing for re-KT, as well as waitlist mortality, and re-KT among those who were listed (n=46,613) by age, sex, and race using the Kaplan Meier method and adjusted Cox proportional hazards models.

*Results: The number of graft failures increased from 2,320 in 1995 to 4,988 in 2017. There were substantial increases in the proportion of older (≥65 years) patients with graft failure; 5.7% in 1995 to 27.5% in 2017. The proportion of Black patients remained steady among those with graft failure, 33.5% in 1995 and 31.3% in 2017, while the proportion of women was 41.1% in 1995 and 39.9% in 2017. The chance of listing for re-KT was lower among older patients (adjusted hazard ratio [aHR]=0.37, 95% CI: 0.36-0.39) and Black patients (aHR=0.79, 95% CI: 0.77-0.81). Only, older patients had a higher risk of waitlist mortality (aHR=2.59, 95% CI: 2.40-2.79). Older patients (aHR=0.92, 95% CI: 0.85-0.99) and Black patients (aHR=0.53, 95% CI: 0.50-0.55) were less likely to receive re-KT. There were no differences in listing, waitlist mortality, or KT by sex.

*Conclusions: There are age and racial disparities in access to re-KT. Efforts should be made to improve equitable access to re-KT for older and Black patient with graft failure.

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