Introduction: Brazil holds the largest public transplant system globally. The State of Minas Gerais has the second-highest burden of end-stage renal disease (ESRD) in the Southeastern region of Brazil. Still, it holds seventh place in the number of kidney transplants. It is crucial to understand barriers to increasing the number of dialysis patients who get waitlisted for a transplant.

Setting & Participants: 23,927 incidents patients (2015-2019) who received chronic hemodialysis therapy for at least 90 days in Minas Gerais were identified within the DATASUS System and National transplant System (SNT) at 84 dialysis facilities and followed through September 2020.

Outcomes: Waitlisting and transplanting ANALYTICAL APPROACH: Multivariable time-dependent Cox models for the incident population.

Results: Among 23,927 adult patients on incident dialysis, 3,442 (14%) were listed and 1,211 (4.4%) transplanted in six years. Factors significantly associated with a lower waitlisting and transplantation (p < 0.0001) included non-profit status dialysis facilities, female gender, >60 years old and treatment in the south part of the state.

Conclusion: Geographic differences across the state can identify opportunities to increase funding for healthcare resources in proportion to patient and disease burdens. Transplant centers must assist underserved populations in ensuring equity in access to services. Policies that improve patient access to care are essential to alleviate geographic disparities.