*Purpose: Transplant rate is used as a primary metric of center performance as reported by the SRTR. However, the calculation of transplant rate can be heavily influenced by center waitlisting practices and local population health, and therefore may not accurately represent how well a center is serving its local population.

*Methods: Using USRDS and UNOS data, the population of transplant-eligible adults (age 18-74) for each state was calculated by applying a standard set of criteria (Table) to all adult patients on dialysis in 2014. Eligibility-conditioned transplant rates were calculated for each state by dividing the number of adult transplants performed in 2014 by the eligible population. These rates were compared to waitlist-conditioned transplant rates calculated by dividing the number of adult transplants by the waitlisted adult population.

*Results: State level eligibility-conditioned transplant rates ranged from 1.55 to 6.24 transplants per 100 eligible adults (mean 3.38, SD 1.10). State level waitlist-conditioned ranged from 7.41 to 28.28 transplants per waitlisted adults (mean 14.17, SD 4.77). State performance compared to the mean varied depending on which metric was used, suggesting an effect of center waitlisting practices (Figure).

*Conclusions: Recent proposed changes to allocation of deceased donor kidneys have focused on improving equitable access to transplantation and reducing variability in transplant rates. Our data suggest that waitlisting practices have an effect on reported transplant rates, calling into question whether this is an appropriate metric to be used when benchmarking access to kidney transplantation.

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