Kidney Transplant Disparities in Lupus
RACIAL disparities continue to affect kidney transplant outcomes in patients with systemic lupus erythematosus (SLE), even after the 2014 revision of the Kidney Allocation System designed to improve organ distribution equity.
Study Overview: Post-Reform Improvements in Access
This 20-year retrospective cohort study analyzed data from more than 10,500 adults with lupus-related end-stage kidney disease who received transplants between 2005 and 2024. Patients were divided into two cohorts: those transplanted before the 2014 Kidney Allocation System (KAS) revision and those transplanted afterward. Researchers examined differences in wait times, graft failure, and mortality across racial and ethnic groups.
Following the policy change, Black patients, who historically experienced the longest average wait times, saw the largest reduction in waiting periods, with wait times dropping by an average of 143 days compared with White patients. Other racial and ethnic groups showed little to no change.
Disparities in Graft Survival and Outcomes
Despite improved access, 1-year graft failure rates rose across all racial groups after the KAS revision, most notably among Black and Hispanic recipients. Adjusted analyses revealed that, compared with White patients, Black recipients had 46% higher odds of 1-year graft failure and Hispanic recipients had 28% higher odds. Patients in the “Other” category showed lower odds of graft failure, while mortality remained largely unchanged across groups.
The findings suggest that the 2014 policy may have improved fairness in access to transplantation but failed to translate into better early post-transplant outcomes for minority patients. Researchers highlight the need for further investigation into potential factors, including immunologic matching and postoperative care, to ensure equitable outcomes for all patients with lupus-related kidney disease.
Reference: Salia S et al. Racial and Ethnic Disparities in Kidney Transplant Outcomes Among Patients With Systemic Lupus Erythematosus (SLE): A 20-Year Analysis Spanning Before and After the 2014 Kidney Allocation System Revision. Abstract 1707. ACR Convergence, 25th-29th October, 2025.
