American Journal of Kidney Diseases

Effect of Eliminating Priority Points for HLA-B Matching on Racial Disparities in Kidney Transplant Rates

Published:August 01, 2011DOI:


      African Americans have lower rates of obtaining a deceased donor kidney transplant (DDKT) compared with their white counterparts. One proposed mechanism is differential HLA distributions between African Americans and whites. In May 2003, the United Network for Organ Sharing/Organ Procurement and Transplantation Network changed kidney allocation policy to eliminate priority based on HLA-B matching in an effort to address this disparity. The objective of this study was to quantify the effect of the change in policy regarding priority points for HLA-B matching.

      Study Design

      Observational cohort study.

      Setting & Participants

      A cohort of 178,902 patients registered for a DDKT between January 2000 and August 2009.


      African Americans versus whites before and after the policy change. Cox models were adjusted for age, sex, diabetes, dialysis type, insurance status, education, panel-reactive antibody level, and blood type.


      Adjusted relative rates (aRRs) of deceased donor kidney transplant for African Americans compared with whites.


      Time from initial active wait listing to DDKT, censored for living donor kidney transplant and death.


      Before the policy change, African Americans had 37% lower rates of DDKT (aRR, 0.63; 95% CI, 0.60-0.65; P < 0.001). After the policy change, African Americans had 23% lower rates of DDKT (aRR, 0.77; 95% CI, 0.76-0.79; P < 0.001). There was a 23% reduction in the disparity between African Americans and whites after the policy change (interaction aRR, 1.23; 95% CI, 1.18-1.29; P < 0.001).


      As an observational study, findings could have been affected by residual confounding or other changes in practice patterns.


      Racial disparity in rates of DDKT was decreased by the HLA-B policy change, but parity was not achieved. There are unaddressed factors in kidney allocation that lead to continued disparity on the kidney transplant waiting list.

      Index Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to American Journal of Kidney Diseases
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Oriol R.
        • Le Pendu J.
        • Chun C.
        Influence of the original disease, race, and center on the outcome of kidney transplantation.
        Transplantation. 1982; 33: 22-26
        • Alexander G.C.
        • Sehgal A.R.
        Barriers to cadaveric renal transplantation among blacks, women, and the poor.
        JAMA. 1998; 280: 1148-1152
        • Stolzmann K.L.
        • Bautista L.E.
        • Gangnon R.E.
        • McElroy J.A.
        • Becker B.N.
        • Remington P.L.
        Trends in kidney transplantation rates and disparities.
        J Natl Med Assoc. 2007; 99: 923-932
        • Tomson C.R.
        • Foley R.N.
        • Li Q.
        • Gilbertson D.T.
        • Xue J.L.
        • Collins A.J.
        Race and end-stage renal disease in the United States Medicare population: the disparity persists.
        Nephrology (Carlton). 2008; 13: 651-656
        • Young C.J.
        • Gaston R.S.
        Renal transplantation in black Americans.
        N Engl J Med. 2000; 343: 1545-1552
        • Held P.J.
        • Kahan B.D.
        • Hunsicker L.G.
        • et al.
        The impact of HLA mismatches on the survival of first cadaveric kidney transplants.
        N Engl J Med. 1994; 331: 765-770
        • Edwards E.B.
        • Bennett L.E.
        • Cecka J.M.
        Effect of HLA matching on the relative risk of mortality for kidney recipients: a comparison of the mortality risk after transplant to the mortality risk of remaining on the waiting list.
        Transplantation. 1997; 64: 1274-1277
        • Gaston R.S.
        • Ayres I.
        • Dooley L.G.
        • Diethelm A.G.
        Racial equity in renal transplantation.
        JAMA. 1993; 270: 1352-1356
        • Kallich J.D.
        • Wyant T.
        • Krushat M.
        The effect of DR antigens, race, sex, and peak PRA on estimated median waiting time for a first cadaver kidney transplant.
        Clin Transpl. 1990; 1: 311-318
        • Kasiske B.L.
        • Neylan III, J.F.
        • Riggio R.R.
        • et al.
        The effect of race on access and outcome in transplantation.
        N Engl J Med. 1991; 324: 302-307
        • Kjellstrand C.M.
        Age, sex, and race inequality in renal transplantation.
        Arch Intern Med. 1988; 148: 1305-1309
        • Sanfilippo F.P.
        • Vaughn W.K.
        • Peters T.G.
        • et al.
        Factors affecting the waiting time of cadaveric kidney transplant candidates in the United States.
        JAMA. 1992; 267: 247-252
        • Ting A.
        • Edwards L.B.
        Human leukocyte antigen in the allocation of kidneys from cadaveric donors in the United States.
        Transplantation. 2004; 77: 610-614
        • Roberts J.P.
        • Wolfe R.A.
        • Bragg-Gresham J.L.
        • et al.
        Effect of changing the priority for HLA matching on the rates and outcomes of kidney transplantation in minority groups.
        N Engl J Med. 2004; 350: 545-551
        • Kerman R.H.
        • Kimball P.M.
        • Van Buren C.T.
        • et al.
        Influence of race on crossmatch outcome and recipient eligibility for transplantation.
        Transplantation. 1992; 53: 64-67
        • Koka P.
        • Cecka J.M.
        Sensitization and crossmatching in renal transplantation.
        Clin Transpl. 1989; 1: 379-390
        • Melancon J.K.
        • Kucirka L.M.
        • Boulware L.E.
        • et al.
        Impact of Medicare coverage on disparities in access to simultaneous pancreas and kidney transplantation.
        Am J Transplant. 2009; 9: 2785-2791