*Purpose: Renal transplantation (RT) offers the best survival and quality of life for patients with end stage renal disease. Every effort should be made to maximize renal transplantation in a timely and equitable manner, however racial disparities in access to transplantation exist. Here we examine the dynamics of access to RT in New York City.

*Methods: This was a retrospective study utilizing the UNOS database includes all adult patients (age > 18) listed for RT between January 2015 and September 2019 at the five major transplant centers in New York City. Patients were classified by race as White, Black, Hispanic or Other as reported by UNOS. Referral gap was defined as the time from transplant eligibility to listing at a transplant center. Allocation time was reported for all transplanted patients and waitlist time was reported for all patients transplanted with deceased donor kidneys. Chi-squared was used for categorical variables and ANOVA test was used for continuous variables.

*Results: Out of 7541 patients listed for RT, 33% received a transplant. Of the transplanted patients a disproportionate amount went to white (43%) compared to Black (26%), Hispanic (30%) and Other (27%) patients (p=0.01). White patients were also more likely to receive a living donor (79%) compared to Black (33%), Hispanic (50%) and Other (50%) patients (p=0.01) (Table 1). Referral gap was significantly shorter for white patients (277 days) compared to black (730 days), Hispanic (514 days) or Other (419 days) patients (p=0.01). Waitlist times for deceased donor recipients were comparable for all patients (White=274, Black=281, Hispanic= 292, Other=332 days, p=0.53). For those who did not receive a living donor transplant, Other patients were the least likely to appear on the list as inactive (32%) compared to White (40%), Black (40%) and Hispanic (56%) patients (p=0.01). Other patients also spent the least percent of their waitlist time inactive (22%) compared to white (30%), black (27%) or Hispanic (33%) patients (p=0.01).

*Conclusions: Racial disparities persist in New York City particularly in respect to access to a transplant center. Racial minorities are disadvantaged in access to living donation and tend to spend longer time on the waitlist. Efforts should be made to mitigate these disparities.

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