Background: Outcome after living donor kidney transplantation (LD) is significantly better than after deceased donor transplantation (DD). Disparities in access to living donor renal transplantation have been widely described in the literature and may depend on many factors. We compared rates of living donor renal transplantation across different UNOS regions and compared factors influencing access to this procedure.

Study Design: All 96,826 adult primary solitary kidney transplants performed between 2009 and 2015 reported to the UNOS/OPTN data base were analyzed. This included 35,112 LD and 61,714 DD renal transplants. Outcomes of the procedure were computed and the likelihood of a LD transplant was estimated using a multiple logistic regression model, adjusted for possible confounders, including age, race, gender, diabetes, year of transplant, panel reactive antibody, body mass index, blood group and UNOS regions.

Results: During the analyzed time period, the outcome of LD vs DD kidney transplants was significantly better (85.7% vs 74.4% graft function at 5-years post-transplant). The use of a LD kidney reduced the relative risk for mortality by 45% and for renal allograft loss by 41%. The access to LD kidney transplantation depended significantly on gender, age, race, blood group, dialysis status, and region. For the analyzed time period, the rate of adult LD transplants varied between 29% and 50% across UNOS regions. Odds of receiving LD kidney for adult recipients were lowest in regions 8 and 11 and highest for region 7. The odds of receiving living donor renal transplantation were significantly lower in African Americans as compared to White (OR=0.29, 95% CI 0.28-0.31). Hispanics were less likely to receive LD renal transplantation as compared to non-Hispanic whites (OR=0.57, 95% CI 0.54-0.59).

Conclusion: For adults, significant regional and racial disparities persist in the United States for access to LD renal transplantation. .Further studies to assess cultural barriers and regional challenges are needed to explain and reduce this problem.

CITATION INFORMATION: Brar A., Gruessner A., Salifu M., Gruessner R., Sumrani N., John D., Tedla F. Living Donor Renal Transplantation in Adult Renal Transplant Recipients Varies Markedly across UNOS Networks Am J Transplant. 2017;17 (suppl 3).

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