Donor and Recipient Ethnicity Impacts Renal Graft Adverse Outcomes

Abstract

Renal transplant outcomes have been shown to be impacted by ethnicity. Prior studies have evaluated the disparate transplant outcomes of Black recipients and recipients of Black donors. However, it has remained unclear whether other donor ethnicities independent of medical comorbidities can influence transplant outcomes. Utilizing the Scientific Registry of Transplant Recipients (SRTR) (with greater than 100,000 patients), we evaluated the effect of each ethnicity, Black, American Indian, Hispanic, Native Hawaiian or other Pacific Islander, and Asian as compared to White recipients on adverse kidney transplant outcomes, assessing for delayed graft function, positive urine protein, acute rejection, and graft failure. Additionally, we assessed the interplay of donor ethnicity on recipient transplant outcomes, which has not previously been comprehensively examined. Logistic regression analysis that took into consideration gender, age, comorbidities, graft type, donor ethnicity, body mass index (BMI), HLA mismatch, ever been on hemodialysis, and time on dialysis indicates that Black recipients have worse outcomes compared to Whites in all outcomes assessed. A logistic regression analysis showed that recipient ethnicity was an independent risk factor for adverse outcomes. Notably, we found that donor ethnicity also independently affects graft outcomes. Hispanic donors lead to better outcomes in Whites and Blacks, while Asian donors have the best outcomes amongst Asian recipients. Recipients of Black donors fared the worst of all ethnicity donors. These data suggest the potential importance of risk stratification for the donor allograft and developing risk calculators that include both donor and recipient ethnicity may be useful, which the current Kidney Donor Profile Index (KDPI) does not currently take into account as they give black donors a different weight, but the same score is assigned to Whites, Asians, and Hispanics.

Perioperative Vasopressors are Associated with Delayed Graft Function in Kidney Transplant Recipients in a Primarily Black and Hispanic Cohort

“…Black patients may require higher doses and longer durations of vasopressors when treated for shock compared to white patients. 9 In kidney transplant specifically, recipient race has been found to be an independent risk factor for graft loss and black and hispanic patients experienced lower overall rates of graft survival compared to white patients. 5,9 In our modeling for DGF, race was not an independent predictor of outcome.…”

“…9 In kidney transplant specifically, recipient race has been found to be an independent risk factor for graft loss and black and hispanic patients experienced lower overall rates of graft survival compared to white patients. 5,9 In our modeling for DGF, race was not an independent predictor of outcome. Only CIT and the exposure to vasopressors were significant predictors.…”

Implementing culturally competent transplant care and implications for reducing health disparities: A prospective qualitative study

“…6 Because LDKT offers longer kidney graft and patient survival than deceased donor kidney transplantation, 7 LDKT disparities may magnify ethnic/racial disparities in transplant outcomes. 8 Northwestern Medicine's ® Hispanic Kidney Transplant Program (HKTP) was established in 2006 to provide culturally competent and linguistically congruent care to Hispanic/Latinx patients and their families seeking evaluation for kidney transplantation. Cultural competency refers to: 'A set of values, principles, behaviours, attitudes, policies and structures that enable organizations and individuals to work effectively in cross-cultural situations'.…”

“…Hispanics/Latinxs waitlisted for kidney transplant received significantly fewer LDKTs than waitlisted non‐Hispanic Whites in 2019: 5.0% versus 12.2% 6 . Because LDKT offers longer kidney graft and patient survival than deceased donor kidney transplantation, 7 LDKT disparities may magnify ethnic/racial disparities in transplant outcomes 8 …”

Very early acute rejection in an Australian and New Zealand kidney transplant population

“…The collective effect of various "other" minority ethnicities on transplant outcomes is not documented in the literature but differences in outcomes between Asian recipients and the predominant racial population in various countries has been previously examined. Hawaiian or other Pacific Islander, and Asian) (160). The origins of the Asians included in the study were not specified but were likely to be diverse.…”