The Effect of the COVID-19 Pandemic on Diagnostic Testing Time Completion for African American End Stage Renal Disease (ESRD) Patients Being Evaluated for Kidney Transplantation

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PURPOSE: The COVID-19 pandemic was directly associated with fewer additions to the kidney transplant waiting list and likely contributed to delays in transplant rates, particularly for African Americans. It remains unclear if the pandemic specifically had an impact on diagnostic testing time completion for African Americans being evaluated for kidney transplant waitlisting. AIMS: To examine the impact of the COVID-19 pandemic on kidney transplant diagnostic test completion time and assess racial disparities between African American and White patients. DESIGN: This retrospective study analyzed data on patients approved for kidney transplantation at a southeastern academic medical center between January 2018 and March 2024 (n = 2144). Time periods were pre-pandemic (January 2018 - February 2020), lockdown and pandemic (March 2020 - March 2022), and "post" pandemic (April 2022 - March 2024). Multiple linear regression was used to evaluate the combined effects of race and pandemic time periods. FINDINGS: African American patients took longer to complete their testing than White patients (227.7 vs. 163.7 days). After adjusting for COVID-19 time periods, African American patients had 59.3 days longer to complete their testing than White patients. Evaluations were completed 84.3 days faster pre-pandemic than post-pandemic. In the post-pandemic period, improvements were smaller for African American patients, and the disparity nearly doubled. CONCLUSION: Racial disparities in kidney transplant evaluation persisted and worsened during the pandemic. There were significant disruptions in evaluation processes. Future research should examine social determinants of health, pre-kidney transplant care coordination during public health crises, and the use of telehealth services to improve equitable access to transplantation.

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