*Purpose: We hypothesized racial/ethnic disparities to access the kidney transplant (KT) waitlist (WL) remain after the implementation of the new kidney allocation system (KAS) at a state level.

*Methods: We used the US Renal Data System (URSRDS) data from 1/1/2004 – 12/31/2018 for ESRD patients who resided in Illinois at the time of dialysis initiation. Inclusion criteria were; 1) 18 -70 years at dialysis initiation, and 2) first KT only. Multi-organ transplant was excluded. A competing risk analysis was conducted with a sub-distribution hazard model stratified by race/ethnicity. Death on dialysis was considered as a competing risk for waitlisting. Sub-distribution hazard ratio (SHR) between the pre-KAS (11/1/2004 – 12/4/2015) and post-KAS (12/5/2015 – 12/31/2018) compared Black and Hispanics to Whites.

*Results: A total of 47,484 patients were included with 39,646 in the pre-KAS and 7,838 patients in the post-KAS era based on initiation date of dialysis. In the pre-KAS group, 10,472 (26.4%) patients were added to the WL. 764 (10.8%) patients enrolled on the WL during the post-KAS era. Before KAS, Black patients had the lowest SHR (0.945, p=0.01) for WL enrollment, with Hispanics (1.331, p<0.001) and others (1.693, p<0.001) above Whites. Post-KAS SHR of WL addition in Blacks fell even lower (0.639, p<0.001), relative to Whites. The SHR dropped somewhat for Hispanics (1.208, p=0.01) and Others (1.551, p<0.001) (Table 1).

*Conclusions: In Illinois, the disparity in access to the WL became worse for Blacks in the post-KAS era. Causes for the widening gap need to be explored, to find mitigation solutions.

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