Schold JD, Mohan S, Huml A, et al. - Despite the development of numerous research studies and policies to improve access to kidney transplantation among patients with ESKD over past decades, dialysis facilities exhibit wide variation in transplant referral rates. Researchers conducted this retrospective cohort study with the aim to evaluate the longitudinal pattern of rates of placement on the transplant waiting list and transplantation among the ESKD population. In addition, they examined if patterns were consistent in the population or differed among patient groups with historically low rates of access to transplantation. The study population comprised 1,309,998 adult patients and exhibited a cumulative 4-year waiting list placement or transplantation of 29.7%, which was unchanged over five eras. The study’s primary findings indicate that the incidence of placement on the transplant waiting list did not improve over a two-decade period from 1997 to 2016. In addition, vulnerable populations showed consistently reduced rates of wait list placement and transplantation. Results thereby suggest the necessity for more effective interventions to enhance access to transplantation in the United States.