BJS02 "Mapping Change: A Twenty-Year Analysis of Racial Equity in the UK Kidney Transplant Care"

Background Racial disparities in kidney transplantation remain a significant healthcare challenge globally. Comprehensive analysis of long-term trends in access and outcomes is crucial for developing targeted interventions and policy changes. Methods This retrospective cohort study (COBIT-UK) analysed data from 19,385 first-time kidney transplant recipients (Black: n = 1,878, 9.7%; White: n = 17,507, 90.3%) using the UK Transplant Registry and UK Renal Registry database. We employed multivariable Cox proportional hazards models, competing risk analyses, and time-varying coefficient models to assess primary outcomes including death-censored graft survival, all-cause mortality, and waitlist outcomes. Secondary outcomes included acute rejection episodes, delayed graft function, and cardiovascular events. Results Annual transplant rates among Black recipients increased five-fold (49 to 250, p<0.001). Black recipients had lower odds of receiving living donor organs (OR 0.43, 95% CI 0.39-0.48, p<0.001) and longer median waiting times (948 vs. 640 days, p<0.001). After adjustment for confounders, death-censored graft survival at 5 years was comparable between groups (HR 1.04, 95% CI 0.89-1.21, p = 0.64). While Black waitlist candidates showed higher mortality (HR 1.56, 95% CI 1.32-1.85, p<0.001), post-transplant survival benefit was significant (HR 0.42, 95% CI 0.35-0.51, p<0.001). Competing risk analysis revealed no differences in the cause-specific hazard of graft failure (subdistribution HR 1.08, 95% CI 0.92-1.27, p = 0.34). Regional-level analysis showed minimal variation in outcomes (ICC = 0.03). Conclusions Despite improved access to transplantation for Black recipients, disparities persist in living donation rates and waiting times. Post-transplant outcomes are comparable between groups, suggesting equitable post-transplant care.