Kidney Transplantation Outcomes and Disparities
Summary
Kidney transplantation offers superior long-term survival and quality of life compared with dialysis and is regarded as the treatment of choice for end-stage kidney disease. Advances in surgical techniques, organ preservation and immunosuppressive regimens have improved one-year and five-year graft survival, yet overall outcomes vary by donor source, recipient age and comorbidity. Living donor transplants generally achieve higher graft survival and reduced waiting times but introduce ethical and logistical complexities in donor evaluation. Despite clinical progress, significant disparities persist at each stage of the transplant care continuum—referral, evaluation, waitlisting, transplantation and post-transplant care. Social determinants of health such as race, ethnicity, socioeconomic status, geographic location and health literacy influence access to transplantation and post-transplant outcomes. Marginalised groups often experience delayed referral, lower rates of listing and reduced likelihood of living donation. Interventions to address these gaps include patient education, community engagement, performance feedback and policy reforms. A global perspective reveals variation in equity across health systems, underscoring the need for tailored strategies that combine clinical optimisation with structural and cultural competence to ensure fair access and optimal outcomes for all patient groups.
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Kidney Transplantation Outcomes and Disparities publication trend
The graph below shows the total number of articles in kidney transplantation outcomes and disparities across all publications each year (not limited to Nature Index journals).
Technical terms
End-stage kidney disease (ESKD): Irreversible loss of kidney function requiring dialysis or transplantation.
Graft survival: Duration for which a transplanted kidney remains functional in the recipient.
Waitlist: Official registry of patients approved for deceased or living donor transplantation.
Living donor kidney transplantation (LDKT): Transplantation using a kidney from a living individual, typically a relative or friend.
Social determinants of health: Socioeconomic, cultural and environmental factors that influence health outcomes and access to care.
References
- Effect of a Novel Multicomponent Intervention to Improve Patient Access to Kidney Transplant and Living Kidney Donation. JAMA Internal Medicine (2023).
- Identifying when racial and ethnic disparities arise along the continuum of transplant care: a national registry study. The Lancet Regional Health - Americas (2024).
- A scoping review of inequities in access to organ transplant in the United States. International Journal for Equity in Health (2022).
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