A Literature Review: Racial Disparities in Kidney Transplantation Through Genetic, Physiological, and Structural Factors

Racial disparities in kidney transplantation are quite common, but the varying contribution of genetic, physiological, and structural factors remains unclear. In many studies, Black patients were over-represented among those with end-stage kidney disease and kidney transplant waitlists, but were under-represented among kidney transplant recipients, particularly in the preemptive listing. Genetic variations in HLA allelic diversity, pharmacogenetic variation in tacrolimus metabolism, and APOL1 risk, may contribute to greater immunologic risk and early post-transplant vulnerability, but may not fully explain the reasons for such disparities in waitlisting or transplant access. In addition, physiological differences, such as higher sensitization and older dialysis methods may also have a role in racial disparities but not eliminate discriminatory racial disparities. This review is used to analyze the findings from studies and clinical trials to identify how race-associated differences in demographics, genetics, physiology, and healthcare access influence kidney transplant waitlisting, allocation, and outcomes. The most significant differences are found across access outcomes such as waitlisting time for a transplant, and HLA match, while differences in graft survival are less apparent once a patient has received a kidney. Different studies are compared for the factors weighed into consideration within their paper. This review emphasizes the further steps necessary to decrease racial discrimination within kidney transplantation such as bias aware education for providers and new standard protocols.