A Retrospective Analysis of National Kidney Registry Integration at a Single Center in the Northern Great Plains.

Background: Despite the National Kidney Registry's (NKR) widespread adoption, limited data exist to explain center-specific trends in live kidney donation (LKD) in rural areas. Methods: A retrospective review of 1776 referrals (894 before and 882 after NKR integration on February 1, 2018) for LKD at our center between June 1, 2012, and May 31, 2022, was performed. LKD referrals were comparatively analyzed between pre- and post-NKR phases and followed through subsequent evaluation, donation, or termination of donor candidacy. Results: Both pre- and post-NKR, donors were most likely to be White (93.2% vs. 89.4%, p=0.33), women (73.0% vs. 66.0%, p=0.51), from South Dakota or neighboring states (97.3% vs. 89.4%, p=0.11), and employed (95.9% vs. 95.7%, p=0.99). Following NKR affiliation, our center experienced a significant increase in LKDs (74 vs. 47, p=0.008), most notably from nondirected (9 vs. 1, p=0.04) and rural (37 vs. 18, p=0.099) donors and those from socioeconomically disadvantaged (Area Deprivation Index: 3 vs. 4 state decile, p=0.055, and 47 vs. 54 national percentile, p=0.056) communities. Post-NKR donor pool showed greater diversity in educational backgrounds and lower rates of tobacco and illicit drug use. Also, post-NKR referrals were evaluated, on average, 10 days sooner (66 vs. 76 days and p=0.01) and were less likely to retract or be lost to follow-up after evaluation (25.1% vs. 32.7% and p=0.04). Conclusion: NKR potentiates expanded LKD at rural transplant centers. Efforts to increase LKD among men and People of Color remain areas of opportunity.