Race and Transplantation Outcomes Among Patients With ADPKD

The most common genetic cause of end-stage kidney disease (ESKD) is autosomal dominant polycystic kidney disease (ADPKD). ADPKD occurs without racial predilection. Generally, non-White patients with ESKD have limited access to kidney transplantation, particularly living donor transplantation. Sambhavi Krishnamoorthy, MBBS, and colleagues conducted a study examining long-term outcomes of patients with ADPKD-associated ESKD by self-reported race, with an emphasis on the trajectory of estimated post-transplant survival (EPTS) scores over time.

Using data from the United Network for Organ Sharing Standard Transplant Analysis and Research files, the researchers identified 32,611 ADPKD transplant recipients from January 2000 to December 2022. The time from the date of waitlisting to transplant was used to calculate EPTS scores. The cumulative incidences of living and deceased donor transplants were calculated and plotted, and Cox models were made for graft failure and death. A subdistribution hazards model for graft failure accounted for death as a competing outcome, with adjustments for patient, donor, and transplant factors.

Compared with White patients with ADPKD, all other groups had longer dialysis duration, more delayed graft function, and fewer living and preemptive transplants. At each point on the waitlist, Black and Hispanic patients had lower mean EPTS scores compared with White patients. Due to longer waiting times, EPTS scores were less likely to be less than 20% in Black and Hispanic patients at the time of transplant.

Compared with White patients, the risk for graft failure with death as a competing risk was significantly higher in Black patients. Graft survival was similar among Asian and Hispanic patients; patient survival was better among Asian and Hispanic patients compared with White patients.

In conclusion, the researchers said, “Waitlist experience, allograft quality, and post-transplant outcomes of patients with ADPKD are influenced by patient race.”

Source: Krishnamoorthy S, et al. Clin J Am Soc Nephrol. 2025;20(4):563-572. doi:10.2215/CJN.0000000626