Delivery of transplant care among Hmong kidney transplant recipients: Outcomes from a single institution

Abstract

Kidney transplantation entails well‐coordinated complex care delivery. Patient‐provider cultural and linguistic discordance can lead to healthcare disparities. We analyzed kidney transplantation outcomes among our institution's Hmong recipients using a retrospective cohort study. From 1995 to 2015, 2164 adult (age ≥18) recipients underwent kidney transplantation at our institution; 78 self‐identified as Hmong. Survival rates were analyzed and compared to Caucasian recipients (n = 2086). Fifty (64.1%) Hmong recipients consistently requested interpreters. Mean follow‐up was 9.8 years for both groups. Hmong recipients (N = 78) were on average younger at transplant (45.7 vs 49.7 years; P = 0.02), more likely to be female (56% vs 38%; P = 0.001), and had higher gravidity (5.0 vs 1.9 births; P < 0.001). There were 13 (16.7%) Hmong living donor recipients, who were younger (32.8 vs 42.9 years; P = 0.006) at transplant compared to Caucasians (1429, 68.5%). Hmong 1‐ and 5‐year patient survival was 100%; Caucasians, 97.1% and 88% (P < 0.001). Hmong 1‐ and 5‐year graft survival was 98.7% and 84.9%; Caucasians 94.8% and 80.9% (P = 0.013). One‐ and 5‐year rejection‐free survival showed no difference (88.9% vs 82.4%; 86.7% vs 83.4%, P = 0.996). Despite cultural and linguistic differences between Hmong recipients and providers, we found no evidence of inferiority in KT outcomes in the Hmong population.

Transplantation and immigration: Comparing infectious complications and outcomes between foreign‐born and US‐born kidney transplant recipients in Minnesota

“…Despite differences in rejection rates, there were no differences in the rates of stable/improving graft function at the end of the year or the overall 1‐year survival rate between FBKTR and USKTR. This finding is consistent with previous literature from and outside the US reporting that FBKTR have similar or slightly better outcomes related to their younger age and fewer comorbidities when compared to USKTR 3,13,35,36 …”

“…This finding is consistent with previous literature from and outside the US reporting that FBKTR have similar or slightly better outcomes related to their younger age and fewer comorbidities when compared to USKTR. 3,13,35,36 After adjusting for covariates in the multivariable analysis, the number of infections was not significantly different in FBKTR versus USKTR, but it was more frequent in patients who had previous kidney transplantation. Patients with prior renal transplant are commonly HLA-sensitized due to the exposure to a previous allograft increasing their rates of rejection and need for higher immunosuppression that consequently can increase the risk of infectious episodes.…”

“…Although previous studies in pediatric and adult RIM kidney transplant recipients (KTRs) have demonstrated similar outcomes of graft function and mortality compared to US-born KTRs (USKTR), none of these studies have reported detailed information about the type and timing of infectious episodes. 3,[12][13][14][15] More granular data could guide and improve the prevention, diagnostics, and treatment of post-transplant infections, especially for foreign-born KTRs (FBKTR). This study compares the frequency and etiology of infectious complications and outcomes between FBKTR and USKTR in two large transplant centers in the state of Minnesota.…”

“…However, this expanded screening for these latent infections is not standardized and may be potentially insufficient for early detection and appropriate management of RIM patients. Although previous studies in pediatric and adult RIM kidney transplant recipients (KTRs) have demonstrated similar outcomes of graft function and mortality compared to US‐born KTRs (USKTR), none of these studies have reported detailed information about the type and timing of infectious episodes 3,12–15 . More granular data could guide and improve the prevention, diagnostics, and treatment of post‐transplant infections, especially for foreign‐born KTRs (FBKTR).…”

Evaluation of infectious risk and outcomes in the hmong renal transplant population

“…In fact, the Hmong people not only have equivalent or lower risk of infection, they appear to have superior graft and patient survival. The findings of our study corroborate the recent data from Minnesota and build upon them by exploring infectious risk . These are important findings as they may demonstrate that the inferior population health outcomes in the Hmong community are reflective of access and acceptance of medical intervention, more so than genetic predisposition.…”