Background: The persistent challenges of bridging healthcare disparities for African Americans (AAs) in need of kidney transplantation continue to be unresolved at the national level. This healthcare disparity is multifactorial: stemming from limited kidney donors suitable for AAs; inconsistent care coordination and suboptimal risk factor control; social determinants, low socioeconomic status, reduced access to care; and mistrust of clinicians and the healthcare system. Summary: There are numerous opportunities to significantly lessen the disparities in kidney transplantation for AAs through the following measures: the adoption of new care and patient engagement models that include education, enhanced practice-level cultural sensitivity, and timely referral as well as increased research on the impact of the environment on genetic risk, and implementation of new transplantation-related policies. Key Messages: This systematic review describes pretransplant concerns related to access to kidney transplantation, posttransplant complications, and policy interventions to address the challenging issues associated with kidney transplantation in AAs.

1.
Malek SK, Keys BJ, Kumar S, Milford E, Tullius SG: Racial and ethnic disparities in kidney transplantation. Transpl Int 2011;24:419-424.
2.
Saran R, Li Y, Robinson B, Ayanian J, Balkrishnan R, Bragg-Gresham J, Chen JT, Cope E, Gipson D, He K, Herman W, Heung M, Hirth RA, Jacobsen SS, Kalantar-Zadeh K, Kovesdy CP, Leichtman AB, Lu Y, Molnar MZ, Morgenstern H, Nallamothu B, O'Hare AM, Pisoni R, Plattner B, Port FK, Rao P, Rhee CM, Schaubel DE, Selewski DT, Shahinian V, Sim JJ, Song P, Streja E, Kurella Tamura M, Tentori F, Eggers PW, Agodoa LY, Abbott KC: US renal data system 2014 annual data report: epidemiology of kidney disease in the united states. Am J Kidney Dis 2015;66(1 suppl 1):Svii, S1-S305.
3.
Taber DJ, Gebregziabher M, Hunt KJ, Srinivas T, Chavin KD, Baliga PK, Egede LE: Twenty years of evolving trends in racial disparities for adult kidney transplant recipients. Kidney Int 2016;90:878-887.
4.
Epstein AM, Ayanian JZ, Keogh JH, Noonan SJ, Armistead N, Cleary PD, Weissman JS, David-Kasdan JA, Carlson D, Fuller J, Marsh D, Conti RM: Racial disparities in access to renal transplantation - clinically appropriate or due to underuse or overuse? N Engl J Med 2000;343:1537-1544, 1532 p preceding 1537.
5.
Monson RS, Kemerley P, Walczak D, Benedetti E, Oberholzer J, Danielson KK: Disparities in completion rates of the medical prerenal transplant evaluation by race or ethnicity and gender. Transplantation 2015;99:236-242.
6.
Schold JD, Buccini LD, Reese PP, Poggio ED, Goldfarb DA: Effect of dialysis initiation for preemptively listed candidates in the revised kidney allocation policy. Am J Transplant 2014;14:2855-2860.
7.
Reddan DN, Szczech LA, Klassen PS, Owen WF Jr: Racial inequity in America's esrd program. Semin Dial 2000;13:399-403.
8.
Leggat JE Jr, Bloembergen WE, Levine G, Hulbert-Shearon TE, Port FK: An analysis of risk factors for withdrawal from dialysis before death. J Am Soc Nephrol 1997;8:1755-1763.
9.
Salter ML, Kumar K, Law AH, Gupta N, Marks K, Balhara K, McAdams-DeMarco MA, Taylor LA, Segev DL: Perceptions about hemodialysis and transplantation among African American adults with end-stage renal disease: inferences from focus groups. BMC Nephrol 2015;16:49.
10.
Wachterman MW, McCarthy EP, Marcantonio ER, Ersek M: Mistrust, misperceptions, and miscommunication: a qualitative study of preferences about kidney transplantation among African Americans. Transplant Proc 2015;47:240-246.
11.
Gillespie A, Hammer H, Lee J, Nnewihe C, Gordon J, Silva P: Lack of listing status awareness: results of a single-center survey of hemodialysis patients. Am J Transplant 2011;11:1522-1526.
12.
Davenport CB: The work of the eugenics record office. Eugen Rev 1923;15:313-315.
13.
Price GN, Darity WA Jr: The economics of race and eugenic sterilization in North Carolina: 1958-1968. Econ Hum Biol 2010;8:261-272.
14.
Stern AM: Sterilized in the name of public health: Race, immigration, and reproductive control in modern California. Am J Public Health 2005;95:1128-1138.
15.
Davis LA, Grogan TM, Cox J, Weng FL: Inter- and intrapersonal barriers to living donor kidney transplant among black recipients and donors. J Racial Ethn Health Disparities 2016, Epub ahead of print.
16.
Lunsford SL, Simpson KS, Chavin KD, Menching KJ, Miles LG, Shilling LM, Smalls GR, Baliga PK: Racial disparities in living kidney donation: Is there a lack of willing donors or an excess of medically unsuitable candidates? Transplantation 2006;82:876-881.
17.
Alnimri M, Laftavi MR, Kohli R, Said M, Feng L, Patel S, Pankewycz O: African-American women and older patients are at risk for a greater decline in renal function following living kidney donation. Transplant Proc 2011;43:512-515.
18.
Locke JE, Sawinski D, Reed RD, Shelton B, MacLennan PA, Kumar V, Mehta S, Mannon RB, Gaston R, Julian BA, Carr JJ, Terry JG, Kilgore M, Massie AB, Segev DL, Lewis CE: Apolipoprotein L1 and chronic kidney disease risk in young potential living kidney donors. Ann Surg 2017, Epub ahead of print.
19.
Riella LV, Sheridan AM: Testing for high-risk apol1 alleles in potential living kidney donors. Am J Kidney Dis 2015;66:396-401.
21.
Rodrigue JR, Paek MJ, Egbuna O, Waterman AD, Schold JD, Pavlakis M, Mandelbrot DA: Making house calls increases living donor inquiries and evaluations for blacks on the kidney transplant waiting list. Transplantation 2014;98:979-986.
22.
Fan PY, Ashby VB, Fuller DS, Boulware LE, Kao A, Norman SP, Randall HB, Young C, Kalbfleisch JD, Leichtman AB: Access and outcomes among minority transplant patients, 1999-2008, with a focus on determinants of kidney graft survival. Am J Transplant 2010;10(4 pt 2):1090-1107.
23.
Foster CE 3rd, Philosophe B, Schweitzer EJ, Colonna JO, Farney AC, Jarrell B, Anderson L, Bartlett ST: A decade of experience with renal transplantation in African-Americans. Ann Surg 2002;236:794-804; discussion 804-805.
24.
Freedman BI, Julian BA, Pastan SO, Israni AK, Schladt D, Gautreaux MD, Hauptfeld V, Bray RA, Gebel HM, Kirk AD, Gaston RS, Rogers J, Farney AC, Orlando G, Stratta RJ, Mohan S, Ma L, Langefeld CD, Hicks PJ, Palmer ND, Adams PL, Palanisamy A, Reeves-Daniel AM, Divers J: Apolipoprotein L1 gene variants in deceased organ donors are associated with renal allograft failure. Am J Transplant 2015;15:1615-1622.
25.
Bleyer AJ, Donaldson LA, McIntosh M, Adams PL: Relationship between underlying renal disease and renal transplantation outcome. Am J Kidney Dis 2001;37:1152-1161.
26.
Chandraker A: The real world impact of APOL1 variants on kidney transplantation. Transplantation 2016;100:16-17.
27.
Ojo A, Knoll GA: Apol1 genotyping of African American deceased organ donors: not just yet. Am J Transplant 2015;15:1457-1458.
29.
Taber DJ, Egede LE, Baliga PK: Outcome disparities between African Americans and caucasians in contemporary kidney transplant recipients. Am J Surg 2017;213:666-672.
30.
Commodore-Mensah Y, Himmelfarb CD, Agyemang C, Sumner AE: Cardiometabolic health in African immigrants to the United States: a call to re-examine research on African-descent populations. Ethn Dis 2015;25:373-380.
31.
Morris AA, Kransdorf EP, Coleman BL, Colvin M: Racial and ethnic disparities in outcomes after heart transplantation: a systematic review of contributing factors and future directions to close the outcomes gap. J Heart Lung Transplant 2016;35:953-961.
32.
Israni AK, Weng FL, Cen YY, Joffe M, Kamoun M, Feldman HI: Electronically measured adherence to immunosuppressive medications and kidney function after deceased donor kidney transplantation. Clin Transplant 2011;25:E124-E131.
33.
Weng FL, Israni AK, Joffe MM, Hoy T, Gaughan CA, Newman M, Abrams JD, Kamoun M, Rosas SE, Mange KC, Strom BL, Brayman KL, Feldman HI: Race and electronically measured adherence to immunosuppressive medications after deceased donor renal transplantation. J Am Soc Nephrol 2005;16:1839-1848.
34.
Oetting WS, Schladt DP, Guan W, Miller MB, Remmel RP, Dorr C, Sanghavi K, Mannon RB, Herrera B, Matas AJ, Salomon DR, Kwok PY, Keating BJ, Israni AK, Jacobson PA; DeKAF Investigators: Genomewide association study of tacrolimus concentrations in African American kidney transplant recipients identifies multiple CYP3A5 alleles. Am J Transplant 2016;16:574-582.
35.
Sanghavi K, Brundage RC, Miller MB, Schladt DP, Israni AK, Guan W, Oetting WS, Mannon RB, Remmel RP, Matas AJ, Jacobson PA: Genotype-guided tacrolimus dosing in African-American kidney transplant recipients. Pharmacogenomics J 2017;17:61-68.
36.
Waterman AD, Rodrigue JR, Purnell TS, Ladin K, Boulware LE: Addressing racial and ethnic disparities in live donor kidney transplantation: priorities for research and intervention. Semin Nephrol 2010;30:90-98.
37.
Rodrigue JR, Kazley AS, Mandelbrot DA, Hays R, LaPointe Rudow D, Baliga P: Living donor kidney transplantation: overcoming disparities in live kidney donation in the US - recommendations from a consensus conference. Clin J Am Soc Nephrol 2015;10:1687-1695.
38.
Ladin K, Rodrigue JR, Hanto DW: Framing disparities along the continuum of care from chronic kidney disease to transplantation: barriers and interventions. Am J Transplant 2009;9:669-674.
39.
LaPointe Rudow D, Hays R, Baliga P, Cohen DJ, Cooper M, Danovitch GM, Dew MA, Gordon EJ, Mandelbrot DA, McGuire S, Milton J, Moore DR, Morgievich M, Schold JD, Segev DL, Serur D, Steiner RW, Tan JC, Waterman AD, Zavala EY, Rodrigue JR: Consensus conference on best practices in live kidney donation: recommendations to optimize education, access, and care. Am J Transplant 2015;15:914-922.
40.
Frohlich KL, Potvin L: Transcending the known in public health practice: the inequality paradox: the population approach and vulnerable populations. Am J Public Health 2008;98:216-221.
41.
Waterman AD, Peipert JD, Hyland SS, McCabe MS, Schenk EA, Liu J: Modifiable patient characteristics and racial disparities in evaluation completion and living donor transplant. Clin J Am Soc Nephrol 2013;8:995-1002.
42.
Kutner NG, Zhang R, Huang Y, Johansen KL: Impact of race on predialysis discussions and kidney transplant preemptive wait-listing. Am J Nephrol 2012;35:305-311.
43.
Waterman AD, Robbins ML, Peipert JD: Educating prospective kidney transplant recipients and living donors about living donation: practical and theoretical recommendations for increasing living donation rates. Curr Transplant Rep 2016;3:1-9.
44.
Rodrigue JR, Cornell DL, Lin JK, Kaplan B, Howard RJ: Increasing live donor kidney transplantation: a randomized controlled trial of a home-based educational intervention. Am J Transplant 2007;7:394-401.
45.
Rodrigue JR, Pavlakis M, Egbuna O, Paek M, Waterman AD, Mandelbrot DA: The “house calls” trial: a randomized controlled trial to reduce racial disparities in live donor kidney transplantation: rationale and design. Contemp Clin Trials 2012;33:811-818.
46.
Rodrigue JR, Cornell DL, Kaplan B, Howard RJ: A randomized trial of a home-based educational approach to increase live donor kidney transplantation: effects in blacks and whites. Am J Kidney Dis 2008;51:663-670.
47.
DePasquale N, Hill-Briggs F, Darrell L, Boyer LL, Ephraim P, Boulware LE: Feasibility and acceptability of the TALK social worker intervention to improve live kidney transplantation. Health Soc Work 2012;37:234-249.
48.
DePasquale N, Hill-Briggs F, Darrell L, Ephraim PL, Falcone B, Shafer C, Lewis-Boyer L, Boulware LE: The talking about live kidney donation (TALK) social worker intervention: putting it into practice. J Nephrol Soc Work 2013;37:13-18.
49.
Boulware LE, Hill-Briggs F, Kraus ES, Melancon JK, Falcone B, Ephraim PL, Jaar BG, Gimenez L, Choi M, Senga M, Kolotos M, Lewis-Boyer L, Cook C, Light L, DePasquale N, Noletto T, Powe NR: Effectiveness of educational and social worker interventions to activate patients' discussion and pursuit of preemptive living donor kidney transplantation: a randomized controlled trial. Am J Kidney Dis 2013;61:476-486.
50.
Strigo TS, Ephraim PL, Pounds I, Hill-Briggs F, Darrell L, Ellis M, Sudan D, Rabb H, Segev D, Wang NY, Kaiser M, Falkovic M, Lebov JF, Boulware LE: The talks study to improve communication, logistical, and financial barriers to live donor kidney transplantation in African Americans: protocol of a randomized clinical trial. BMC Nephrol 2015;16:160.
51.
Patzer RE, Paul S, Plantinga L, Gander J, Sauls L, Krisher J, Mulloy LL, Gibney EM, Browne T, Zayas CF, McClellan WM, Arriola KJ, Pastan SO; Southeastern Kidney Transplant Coalition: A randomized trial to reduce disparities in referral for transplant evaluation. J Am Soc Nephrol 2017;28:935-942.
52.
Waterman AD, McSorley AM, Peipert JD, Goalby CJ, Peace LJ, Lutz PA, Thein JL: Explore transplant at home: a randomized control trial of an educational intervention to increase transplant knowledge for black and white socioeconomically disadvantaged dialysis patients. BMC Nephrol 2015;16:150.
53.
Waterman AD, Morgievich M, Cohen DJ, Butt Z, Chakkera HA, Lindower C, Hays RE, Hiller JM, Lentine KL, Matas AJ, Poggio ED, Rees MA, Rodrigue JR, LaPointe Rudow D; American Society of Transplantation: Living donor kidney transplantation: Improving education outside of transplant centers about live donor transplantation - recommendations from a consensus conference. Clin J Am Soc Nephrol 2015;10:1659-1669.
54.
Waterman AD, Robbins ML, Paiva AL, Peipert JD, Kynard-Amerson CS, Goalby CJ, Davis LA, Thein JL, Schenk EA, Baldwin KA, Skelton SL, Amoyal NR, Brick LA: Your path to transplant: a randomized controlled trial of a tailored computer education intervention to increase living donor kidney transplant. BMC Nephrol 2014;15:166.
55.
Patzer RE, Perryman JP, Pastan S, Amaral S, Gazmararian JA, Klein M, Kutner N, McClellan WM: Impact of a patient education program on disparities in kidney transplant evaluation. Clin J Am Soc Nephrol 2012;7:648-655.
56.
Garonzik-Wang JM, Berger JC, Ros RL, Kucirka LM, Deshpande NA, Boyarsky BJ, Montgomery RA, Hall EC, James NT, Segev DL: Live donor champion: finding live kidney donors by separating the advocate from the patient. Transplantation 2012;93:1147-1150.
57.
https://www.kidney.org/patients/peers (accessed January 25, 2017).
58.
Sullivan C, Leon JB, Sayre SS, Marbury M, Ivers M, Pencak JA, Bodziak KA, Hricik DE, Morrison EJ, Albert JM, Navaneethan SD, Reyes CM, Sehgal AR: Impact of navigators on completion of steps in the kidney transplant process: a randomized, controlled trial. Clin J Am Soc Nephrol 2012;7:1639-1645.
59.
Gutierrez OM, Isakova T, Smith K, Epstein M, Patel N, Wolf M: Racial differences in postprandial mineral ion handling in health and in chronic kidney disease. Nephrol Dial Transplant 2010;25:3970-3977.
60.
Gutierrez OM, Parsa A, Isakova T, Scialla JJ, Chen J, Flack JM, Nessel LC, Gupta J, Bellovich KA, Steigerwalt S, Sondheimer JH, Wright JT Jr, Feldman HI, Kusek JW, Lash JP, Wolf M: Genetic African ancestry and markers of mineral metabolism in CKD. Clin J Am Soc Nephrol 2016;11:653-662.
61.
Peralta CA, Lin F, Shlipak MG, Siscovick D, Lewis C, Jacobs DR Jr, Bibbins-Domingo K: Race differences in prevalence of chronic kidney disease among young adults using creatinine-based glomerular filtration rate-estimating equations. Nephrol Dial Transplant 2010;25:3934-3939.
63.
Huang E, Parke C, Mehrnia A, Kamgar M, Pham PT, Danovitch G, Bunnapradist S: Improved survival among sickle cell kidney transplant recipients in the recent ERA. Nephrol Dial Transplant 2013;28:1039-1046.
64.
Kopp JB, Winkler CA, Nelson GW: Myh9 genetic variants associated with glomerular disease: what is the role for genetic testing? Semin Nephrol 2010;30:409-417.
65.
Waterman AD, Peipert JD, Goalby CJ, Dinkel KM, Xiao H, Lentine KL: Assessing transplant education practices in dialysis centers: comparing educator reported and medicare data. Clin J Am Soc Nephrol 2015;10:1617-1625.
66.
Axelrod DA, Dzebisashvili N, Schnitzler MA, Salvalaggio PR, Segev DL, Gentry SE, Tuttle-Newhall J, Lentine KL: The interplay of socioeconomic status, distance to center, and interdonor service area travel on kidney transplant access and outcomes. Clin J Am Soc Nephrol 2010;5:2276-2288.
67.
Schold JD, Gregg JA, Harman JS, Hall AG, Patton PR, Meier-Kriesche HU: Barriers to evaluation and wait listing for kidney transplantation. Clin J Am Soc Nephrol 2011;6:1760-1767.
68.
Patzer RE, Amaral S, Wasse H, Volkova N, Kleinbaum D, McClellan WM: Neighborhood poverty and racial disparities in kidney transplant waitlisting. J Am Soc Nephrol 2009;20:1333-1340.
69.
Gill JS, Tonelli M: Penny wise, pound foolish? Coverage limits on immunosuppression after kidney transplantation. N Engl J Med 2012;366:586-589.
70.
Stegall MD, Stock PG, Andreoni K, Friedewald JJ, Leichtman AB: Why do we have the kidney allocation system we have today? A history of the 2014 kidney allocation system. Hum Immunol 2017;78:4-8.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.