*Purpose: VA kidney transplant patients present challenges that may limit their listing opportunities in the private sector. We sought to study the medical and psychosocial listing characteristics of patients referred for kidney transplant to one regional VA kidney transplant center.

*Methods: Following IRB approval, data was collected on 375 veteran patients presenting for their first kidney transplant evaluation between July 2015 and December 2018. Demographic and functional data, and reasons for deferral and denial were collected and compared among patients accepted and denied for transplant listing. Deferral/Denial reasons were individually recorded and grouped into medical, psychosocial, and functional categories.

*Results: 97% of evaluated patients were male, 57% Caucasian, 64% diabetic, 97% hypertensive, median age 62.5. Causes of renal failure included diabetes (51%), hypertension (18%), FSGS (8%), PKD (6%), urologic (3%), GN (3%) and other (8%). Ninety-eight (26%) patients were initially accepted, 95 (25%) denied and 180 (48%) deferred for listing. Patients immediately denied for transplant were more likely to be diabetic, have a higher BMI, and have more medical, functional, and psychosocial issues per patient compared with immediately accepted patients. Age, race and length of time on dialysis were not different among listed and denied patients. Psychiatric, cognitive, or compliance issues were present in 64% of patients. Among the 184 with psychiatric diagnoses, the most prevalent problems were depression (31%), PTSD (19%) and anxiety (16%). Drug or alcohol abuse history was present in 39% and 41% of patients, respectively. Among deferred patients, 61% were eventually listed. Paradoxically, among initially deferred patients, those eventually listed had more medical (93.6% vs. 79.0%, p = 0.004) and psychosocial issues per patient (48.4% vs. 40.9%, p=0.3) than those denied. Of the 75 patients deferred due wholly or in part to psychosocial issues, 60% were eventually listed. Transplant outcomes are within accepted national norms.

*Conclusions: Despite a high prevalence of psychosocial and medical comorbidities, the majority of referred veteran patients were listed. The high prevalence of psychosocial issues among veteran transplant candidates and those successfully listed may indicate that not only are the patients unique, but that the VA provides unique services that support these candidates.

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