Association of immigration background with kidney graft function in a publicly funded health system: a nationwide retrospective cohort study in Italy

Abstract

The impact of immigration background on kidney graft function (eGFR) is unknown. Italy has a publicly funded health system with universal coverage. Since immigration from non-European Union (EU) countries beyond Eastern Europe is a recent and extensive phenomenon, Italy is a rather unique setting for studying the effect of immigration status as a socioeconomic and cultural condition. We retrospectively identified all adult deceased donor kidney transplant recipients (KTRs) in Italy (2010-2015) and followed them until death, dialysis or 5-years post-transplantation; 6346 were EU-born, 161 Eastern European-born, and 490 non-Europeanborn. We examined changes in eGFR after 1-year post-transplant using multivariable-adjusted joint longitudinal survival random-intercept Cox regression. Compared to EU-born KTRs, in non-European-born KTRs the adjusted average yearly eGFR decline was À0.96 ml/min/year (95% confidence interval: À1.48 to À0.45; P < 0.001), whereas it was similar in Eastern European-born KTRs [+0.02 ml/min/year (À0.77 to +0.81; P = 0.96)]. Adjusted 5-year transplant survival did not statistically differ between non-European-born, Eastern European-born, and EU-born. In those surviving beyond 1-year, it was 91.8% in EU-born (87.1-96.8), 92.5% in Eastern European-born (86.1-99.4), and 89.3% in non-European-born KTRs (83.0-96.0). This study provides evidence that among EU KTRs, non-European immigration background is associated with eGFR decline.

Kidney transplantation and withdrawal rates among wait-listed first-generation immigrants in Italy

“…In fact, although Italy has a publicly funded health system with universal coverage, prior research has shown that non-European immigration background is associated with reduced kidney graft function following KT. 18 …”

Taking a “Care Pathway/Whole Systems” Approach to Equality Diversity Inclusion (EDI) in Organ Donation and Transplantation in Relation to the Needs of “Ethnic/Racial/Migrant” Minority Communities: A Statement and a Call for Action

“…Yet, one study highlighted that, where ethnicity was not available, South Asian origin was derived by name screening [21], whereas another one explained that Black ethnicity was attributed to individuals that are genetically of Sub-Saharan African origin (mostly African Caribbean or West African) [23]. Studies from other European countries beyond the UK define these populations as first-generation migrants/ethnic minority populations based on country of birth alone [26][27][28], nationality and place of birth [29], citizenship and country of birth of patients and their families to allow the collection of more detailed data regarding migration history [30], and other unspecified factors [31]. Only one review article-which does define these populations as "migrants and ethnic minorities"-states that the data was missing by ethnic group [32], whereas another study classifies kidney transplant patients according to their racial background (i.e., Black) based on country of origin [33].…”

Detecting, preventing and treating non-adherence to immunosuppression after kidney transplantation

“…Constantiner et al , who analysed the adherence of 312 KTRs in New York City through a self-reporting questionnaire, found that younger age and lower income were significantly associated with reported MNA [ 56 ]. A recent European study found that, compared with EU-born KTRs, non-EU-born KTRs had a hazard ratio of graft failure beyond 1 year of 1.36, probably related to barriers to adherence related to recent immigration background [ 58 ].…”