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

Abstract

Background Multiple barriers diminish access to kidney transplantation (KT) in immigrant compared to non-immigrant populations. It is unknown whether immigration status reduces the likelihood of KT after wait-listing despite universal healthcare coverage with uniform access to transplantation. Methods We retrospectively collected data of all adult waiting list (WL) registrants in Italy (2010–20) followed for 5 years until death, KT in a foreign center, deceased-donor kidney transplant (DDKT), living-donor kidney transplant (LDKT) or permanent withdrawal from the WL. We calculated adjusted relative probability of DDKT, LDKT and permanent WL withdrawal in different immigrant categories using competing-risks multiple regression models. Results Patients were European Union (EU)-born (n = 21 624), Eastern European-born (n = 606) and non-European-born (n = 1944). After controlling for age, sex, blood type, dialysis vintage, case-mix and sensitization status, non-European-born patients had lower LDKT rates compared to other immigrant categories: LDKT adjusted relative probability of non-European-born vs. Eastern European-born 0.51 (95% CI: 0.33–0.79; P = 0.002); of non-European-born vs. EU-Born: 0.65 (95% CI: 0.47–0.82; P = 0.001). Immigration status did not affect the rate of DDKT or permanent WL withdrawal. Conclusions Among EU WL registrants, non-European immigration background is associated with reduced likelihood of LDKT but similar likelihood of DDKT and permanent WL withdrawal. Wherever not available, new national policies should enable coverage of travel and medical fees for living-donor surgery and follow-up for non-resident donors to improve uptake of LDKT in immigrant patients, and provide KT education that is culturally competent, individually tailored and easily understandable for patients and their potential living donors.

Inequities in Organ Donation and Transplantation Among Immigrant Populations in Italy: A Narrative Review of Evidence, Gaps in Research and Potential Areas for Intervention

“…The descriptive details and main findings of the eight included articles are summarized in Table 1 . The period of data collection varied between 1994–2001 [ 48 ] and 2010–2020 [ 49 ]. Studies were published between 2004 and 2022.…”

“…There were two survey studies [ 35 , 36 ] but most had a retrospective design [ 34 , 47 – 51 ]. Of these, five were cohort studies based on national [ 47 , 49 , 50 ] and regional registries [ 34 , 51 ], and one was a single center study [ 48 ]. Articles were categorized according to the following time-points of the ODT process, as described below: • ESKD treatment, • access to the transplant waitlist (WL), • likelihood of transplant, • outcomes of transplant, • transplantation and refusal rates to deceased organ donation.…”

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].…”

“…Further, although living donor kidney transplantation (LDKT) is the best renal replacement therapy for patients with ESKD providing survival advantages over dialysis and deceased donor kidney transplant, studies report diminished uptake of LDKT among migrant and ethnic minority populations [22,[24][25][26]31]. This has the potential to lead to inferior outcomes among migrant and ethnic minority kidney transplant recipients [31].…”

Refusal Rates to Organ Donation in Intensive Care Units Among Immigrant Populations in Italy

“…We have extracted data on 24,222 donors between 1 January 2012 and 31 December 2021 from the Transplant Information System (SIT) of the Italian National Transplant Center (CNT). As in earlier studies [ 4 , 5 ], non-EU-born individuals were categorized as Eastern European-born and non-European-born as distinguished from EU-born (see the Supplementary Appendix for additional details) and included groups that were represented by at least 30 subjects. Out of 24,222 donors, 1,077 (4.4%) were non-EU-born and 1,771 (7.3%) were foreign-born.…”