Outcome after renal transplantation in children from native and immigrant families in Austria

Abstract

Renal transplantation is the therapy of choice for children with end-stage renal disease (ESRD). Ethnicity affects the transplant survival rates substantially, but there has been no European academic evaluation of the effects of immigration on the pediatric renal transplantation outcome. The aim of this study was to compare the outcomes of renal transplantation between the children of immigrant families and the children of native families at the pediatric nephrology unit of the Medical University of Vienna, Austria. We conducted a retrospective study on all children who underwent renal transplantation at our center between January 1997 and June 2005. The patients were separated into two groups according to their immigration backgrounds. During the time frame of our study, 59 children underwent a total of 63 transplantations. Of these children, 42 were from native Austrian and 17 were from first-generation immigrant families. We analyzed the demographic data and outcome parameters for each of the 59 patients. We found no difference in patient and graft survival rates or long-term function between native and immigrant children. The two groups were also comparable in the rates of acute rejection episodes, 24-h blood pressure, and growth velocity. Living donor source had a positive influence on graft function (p=0.06), 24-h blood pressure (p=0.05), and growth velocity (p=0.02) only in the immigrant group. Our retrospective analysis shows no influence of the migration status on the patient or graft outcome, but we did find that immigrant children benefitted more than native children from living donation as opposed to deceased donation. To explain this fact, biological, heath-economical, psychosocial, and cultural background aspects must be investigated.

Does immigration background influence outcomes after renal transplantation?

“…In the immigrant as well as in the native cohort, outcomes improved significantly during the decades, as expected. These data confirm the results of our pilot study in 57 RTx children in 2005 that also found no influence of migration status on patient or graft outcomes [12]. Moreover, the consistency of a similar outcome over the total observation period of more than 30 years adds to the validity these findings.…”

“…The rate of acute rejection episodes decreased from 87.5% during the first decade to 32.8% during the last decade (p<0.01), and the e-GFR 1 increased from 55.3±14.8 to 64.4±27.8 (p=0.01) and e-GFR 2 improved from 42.3± 15.8 to 52.2±19.2 (p=0.06). All of these outcome parameters improved in parallel form in native and immigrant children, and remained comparable, which is in accordance to our results reported earlier [12].…”

“…We found no difference in HLA mismatch between our immigrant and native patient groups; however, in terms of primary renal diseases, we did find that in the immigrant group, congenital diseases were significantly more often the underlying cause of ESRD. This difference was also observed in the smaller population of our pilot study and may be based on a combination of late first antenatal checkup, higher rate of refusing prenatal screening and, possibly, fatalistic attitudes towards termination of pregnancy in this population [12,19,20]. As congenital diseases [in contrast to focal segmental glomerulosclerosis (FSGS), HUS, or membranoproliferative glomerulonephritis (MPGN)] have lower recurrence rates, this disparity may improve graft survival [17].…”

“…In our center, basic immunosuppression was identical for both the native and immigrant patient groups. The use of an intense antibody-based regimen might have overriden a number of biological risk factors in the immigrant group [12]. However, the similar outcome in rejection-free survival over the total observation period-despite major changes in immunosuppressionsuggests additional factors [13].…”

“…In Europe, data on the role of status of immigration in RTx are scarce in adults and virtually absent in the pediatric population, and existing data are inconclusive and mostly limited to immigrants from Africa or Asia [7][8][9][10][11]. We have recently analyzed the data of 57 patients of our transplantation clinic in a pilot study and found comparable outcomes of RTX between children of native Austrian families and children of immigrant families [12]. To the best of our knowledge, this was the first European study on children with migration background and/or minorities from non-African, non-Asian ethnicity.…”