*Purpose: The purpose of this study was to evaluate the disparity, by race, for pre-kidney transplant work-up completion rates of referred patients.

*Methods: We conducted a retrospective cohort study of consecutive adult patient records referred for first time pre-kidney transplant evaluation from January 1, 2015 through December 31, 2016. Patients were grouped based on racial identity as indicated on the medical record as either African American or Caucasian. The drop out reasons for failure to complete the pre-kidney evaluation process or medical review board (MRB) denial were identified as five categories (medical, workup incomplete, financial/social, noncompliance, and other). The “other” category included patient death, relocation, transplant elsewhere, etc. The difference in continuous variables was assessed using one-way analysis of variance and for binary outcomes using chi-square test. Multivariate analysis was conducted when indicated. All p-values were 2-sided and <0.05 was considered to be statistically significant.

*Results: There were 4,939 patient referral entries. We excluded 2,589 patients due to duplications, age <18 years, prior transplant, Hispanic ethnicity, and or race categorized as Asian or Other (N=2,350). Males significantly outnumbered females in each racial group (p<0.001). African American patients were younger (p<0.001), lived closer to the transplant center (p<0.001), had a larger BMI (p=0.007), more dialysis days (p<0.001) and more hypertension (p=0.001) than the Caucasian patients. There was no significant difference by race in the number of referrals that completed the evaluation process at one year (p=0.702). However, when examining the dropout rates by race, statistically significantly more African American patients dropped out during the referral process due to incomplete workups, financial/social problems, and noncompliance as compared to Caucasian patients (p<0.001). Caucasian patients were approved for listing by the MRB at a higher rate compared to African American patients (p=0.003). Caucasian patients were transplanted at greater rates than African American patients (p=0.003).

*Conclusions: The explanations associated with these inequalities are multifaceted and need to be further explored to facilitate the development of solutions that advance the system while improving patient outcomes by race.

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