*Purpose: Among patients with kidney failure, depressive symptoms are common and may be a barrier to completing the complex process of kidney transplantation (KT) evaluation and listing. We sought to explore the burden of depressive symptoms among kidney failure patients being evaluated for KT and the impact of depressive symptom severity on listing for KT.

*Methods: In a prospective cohort study of 3,727 adult patients being evaluated for KT (1/2009-3/2020), depressive symptoms were measured using the 20-item Center for Epidemiologic Studies-Depression (CES-D) Scale and the severity of depressive symptoms was categorized as: none:0; minimal:1-15; mild:16-20; moderate:21-25; severe:26-60. Time to listing by depressive symptoms severity was estimated using Cox Proportional Hazards models, adjusting for demographic, socio-economic, and health factors.

*Results: Depressive symptoms were reported by 18.4% of patients. Younger patients more frequently reported depressive symptoms (age 18-49:22.8%; 50-64:19.1%; ≥65:11.7%; p<0.001). Patients with severe symptoms were 31% less likely to be listed than those without symptoms (hazard ratio [HR]=0.69, 95% confidence interval [CI]=0.56-0.85); the likelihood of being waitlisted decreased with increasing CES-D score (HR for every 5-point worsening=0.94, 95% CI=0.92-0.97).

*Conclusions: Kidney failure patients, particularly younger patients, have a high burden of depressive symptoms at KT evaluation. Regardless of age, patients with depressive symptoms are less likely to be listed for KT. Transplant centers should screen at evaluation to identify patients who would benefit from interventions to reduce depressive symptoms.

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