Race-Neutral Glomerular Filtration Rate Projected to Increase Kidney Transplantation for Black Patients: Initial Policy Effects at a Single Center.

The 2023 organ procurement and transplantation network (OPTN) policy "Modify waiting time for candidates affected by race-inclusive eGFR calculations" for kidney transplantation (KT) was analyzed at our kidney transplant center over a 15-month period following its implementation. A total of 372 adult Black patients active on our KT waiting list were identified, of whom 104 (28%) qualified for waiting-time modification (WTM). The WTM group gained a median total waiting time of 2.4 years, with 36 (35%) receiving KTs compared to 107 (42%) in the no wait-time modification (NWTM) group. Pre-listing time, older age, female gender, and A or B blood type was found to increase likelihood of KT in both groups. Despite lower actual transplant rates during the study period, the WTM group is projected to gain a 25% annual probability of transplant for each additional year of qualifying time. Therefore, while the decision to grant WTM has generated some controversy, short-term outcomes at our center suggest that the OPTN policy change has the potential to improve transplant access among Black patients without necessarily disadvantaging those Black patients who do not benefit from WTM. Longer follow-up is required to determine the intended and unintended effects of the race-neutral GFR (rnGFR) and WTM policy changes.