Autosomal dominant polycystic kidney disease (ADPKD) is a leading genetic cause of end-stage kidney disease (ESKD) and affects people of all races equally. While ADPKD patients tend to have generally better outcomes than those with other kidney diseases, recent findings show that race significantly influences transplant outcomes among these patients. An April 2025 analysis uncovers how inequitable access to transplants—particularly preemptive and living donor transplants—contributes to ongoing outcome disparities.*

Unequal Access to Optimal Transplant Conditions

Using data from over 32,000 transplant recipients with ADPKD (2000–2022), researchers found consistent racial gaps in access to high-quality transplant care. Compared to White patients, Black and Hispanic patients:

• Spent more years on dialysis, and 
• Were less likely to receive living donor or preemptive transplants, both of which are associated with better outcomes. 

As a result, their Estimated Post-Transplant Survival (EPTS) scores, a key measure predicting longevity after transplant, were lower throughout the waitlist period. 

By the time they actually received a transplant, fewer Black and Hispanic patients had top-tier EPTS scores (<20%), largely due to extended wait times.

Disparities in Transplant Outcomes 

Even after adjusting for medical and demographic factors, racial differences remained in transplant success and survival. Black patients faced a higher risk of graft failure (when the transplanted kidney stops working) when accounting for the risk of death. 

Hispanic and Asian patients, however, showed graft survival rates similar to White patients and experienced better overall survival after transplant.

Equity as a Path to Better Survival

These results underscore that while ADPKD does not favor any race biologically, the healthcare system’s inequities affect treatment access and success. Encouragingly, the data suggest that many non-White patients have favorable long-term prospects—if they receive equitable access to early and high-quality transplantation. 

Promoting equity, especially in access to living donor and preemptive transplants, could significantly improve survival for patients with ADPKD across racial groups.

*Krishnamoorthy, S., Satishchandra, N. G., Chapman, A., and McGill, R. (2025, April). 

Effect of Race on Transplantation in Autosomal Dominant Polycystic Kidney Disease. Clinical Journal of the American Society of Nephrology 20(4):p 563-572 https://journals.lww.com/cjasn/abstract/2025/04000/effect_of_race_on_transplantation_in_autosomal.15.aspx 

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