End-stage kidney disease is more common in African Americans (AA) and other minorities (OM) (e.g., Hispanic/Latinos) than Whites (WH). Reports from national data indicate that AA & OM are less likely to be evaluated for kidney transplant (KT), and when they do get evaluated, take significantly longer to complete evaluation than WH. Race disparities persist even after controlling for medical factors, but reasons for race disparities are poorly understood. Ours is the first multi-site, prospective study to recruit the majority of Veterans evaluated for KT within the National VA KT System. Preliminary results from our ongoing longitudinal study will (a) compare rates of evaluation and time to evaluation between AA, OM, and WH Veterans; and (b) show how cultural factors (e.g., perceived discrimination, medical mistrust), psychosocial characteristics (e.g., anxiety, depression), and transplant knowledge are related to time to complete transplant evaluation.

Patients being evaluated for KT completed telephone interviews after their first clinic appointment, and again after they were accepted or found ineligible for KT. AA (n=200) and OM (n=149) Veterans were younger and were less likely to be married than WH (n=272). AA and OM experienced significantly more healthcare discrimination, perceived more overall healthcare racism, had higher levels of medical mistrust, greater family loyalty, and more religious objections to KT than WH (all ps<.05). WH had higher levels of KT knowledge than AA and OM. Despite these difference, we found no significant difference between groups in time to complete evaluation or proportion accepted for transplant. Age, preference for a living donor KT, education, private health insurance, and having a potential living donor predicted time to complete evaluation independently of race.

We found expected race differences on demographic, cultural and psychosocial factors, but not in outcomes, across all 4 VA kidney transplant centers in the US (Iowa, Nashville, Pittsburgh, and Portland). Because the procedures for KT evaluation in the VA are markedly different than those in non-VA settings, we believe that healthcare system factors contributed to reduced disparities in outcomes.

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