Allograft and Patient Outcomes Between Indigenous and Nonindigenous Kidney Transplant Recipients

Abstract

Background. Kidney transplant outcomes of indigenous Australians are poorer compared with nonindigenous Australians, but it is unknown whether the type of acute rejection differs between these patient groups or whether rejection mediates the effect between ethnicity, death-censored graft failure (DCGF), and death with a functioning graft (DWFG). Methods. Biopsy-proven acute rejection (BPAR) rates and types were compared between indigenous and nonindigenous recipients. The associations between ethnicity, BPAR, DCGF, and DWFG were examined using adjusted competing risk analyses, and mediation analysis was conducted to determine whether BPAR mediated the adverse effects between ethnicity and outcomes. Results. Fifty-seven (9.3%) of 616 patients who have received kidney-only transplants between 2000 and 2010 in Western Australia were indigenous. Compared with nonindigenous recipients, BPAR rates were higher in indigenous recipients (42 versus 74 episodes/100 recipients, P < 0.01), with an excess of antibody-mediated rejections. During a median follow-up of 8 years, indigenous recipients were more likely to experience BPAR, DCGF, and DWFG compared with nonindigenous recipients, with adjusted subdistribution hazard ratio of 1.94 (1.39-2.70), 1.53 (0.85-2.76; P = 0.159), and 2.14 (1.13-4.06; P = 0.020), respectively. Although 70% of the effect between ethnicity and DCGF was mediated by BPAR, no similar association was found for DWFG. Conclusions. Indigenous recipients experienced poorer allograft and patient outcomes compared with nonindigenous recipients, with BPAR an important determinant for DCGF. Future research identifying other risk factors and mediators associated with patient survival in indigenous recipients should be considered a priority.

Transplants and Indigenous Peoples: An Initial Approach

“…A quick search using the same descriptors leads to several texts on the topic in different national and cultural contexts -some examples make this diversity clear. [5][6][7][8][9][10][11] Institutionally, there are several successful official initiatives being developed or underway in other countries in order to think about transplants in indigenous people. Suffice it to say that the U.S. Department of Health and Human Services' Office of Minority Health -the equivalent of our Ministério da Saúde -has a specific website on organ donation for Native Americans from the continental United States and Alaska.…”

Transplantes e Povos Indígenas: uma Abordagem Inicial

“…Uma rápida busca usando-se os mesmos descritores leva a vários textos sobre o tema em diferentes contextos nacionais e culturais -alguns exemplos deixam essa diversidade clara. [5][6][7][8][9][10][11] Já institucionalmente, há várias iniciativas oficiais bem-sucedidas sendo desenvolvidas ou em curso em outros países no sentido de se pensar transplantes em povos indígenas. Basta dizer que o Office of Minority Health do U.S. Department of Health and Human Services -o equivalente ao nosso Ministério da Saúde -possui um website específico sobre doação de órgãos para nativos americanos dos Estados Unidos continental e do Alasca.…”

Transplantes y Pueblos Indígenas: un Enfoque Inicial

“…Una rápida búsqueda usándose los mismos descriptores lleva a varios textos sobre el tema en diferentes contextos nacionales y culturales -algunos ejemplos dejan esta diversidad clara. [5][6][7][8][9][10][11] Ya institucionalmente, hay varias iniciativas oficiales exitosas siendo desarrolladas o en curso en otros países en el sentido de pensar transplantes en pueblos indígenas. Basta decir que el Office of Minority Health del U.S. Department of Health and Human Services -el equivalente a nuestro Ministerio de la Salud -posee un websitio específico sobre donación de órganos para nativos americanos de los Estados Unidos continental y de Alaska.…”