Poorer graft survival in ethnic minorities: results from a multi-centre UK study of kidney transplant outcomes

Jf, Medcalf; Pa, Andrews; Bankart, John; Bradley, Clare; Carr, Sue; Feehally, J.; Harden, Paul; Marsh, James E.; Newstead, Chas; Thompson, J F

doi:10.5414/cn106675

Cited by 11 publications

(18 citation statements)

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“…This finding is consistent with the graft failure analysis of Takemoto et al. and unsurprising given that several previous studies have noted higher rates of graft failure among African American RTRs compared with non‐African American RTRs . The reasons behind this disparity are not fully understood, but researchers have speculated that it may be attributable to a combination of immunologic and non‐immunologic (e.g., socioeconomic variables, psychosocial variables) factors .…”

Section: Discussionsupporting

confidence: 88%

Determining the effect of immunosuppressant adherence on graft failure risk among renal transplant recipients

Spivey

Chisholm-Burns

Damadzadeh

et al. 2013

Clinical Transplantation

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The objective was to use the United States Renal Data System (USRDS) to quantify the relationship between immunosuppressant therapy (IST) adherence and risk of graft failure among adult renal transplant recipients (RTRs). A secondary objective was to examine the relationship among select patient characteristics and IST adherence. The study sample included adult RTRs who: received primary transplant between January 1, 1999 and December 31, 2005; experienced graft survival for at least 12 months post-transplant and had at least 12 months of data in the USRDS; utilized Medicare coverage for IST; and were prescribed cyclosporine or tacrolimus. IST adherence was measured by medication possession ratio (MPR). Pearson chi-square tests were used to examine associations between patient characteristics and MPR quartiles. Cox proportional hazards regression was used to assess relationships among time to graft failure, MPR, and patient characteristics. Thirty-one thousand nine hundred and thirteen RTRs met inclusion criteria. Older age, female gender, white race, deceased donors, and tacrolimus were associated with greater adherence (p < 0.001). Cox proportional hazard modeling indicated greater adherence, white race, and having a living donor were significantly associated with longer graft survival (p < 0.05). Future prospective studies should further examine the clinical significance of IST nonadherence as it relates to graft failure.

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Section: Discussionsupporting

confidence: 88%

Determining the effect of immunosuppressant adherence on graft failure risk among renal transplant recipients

Spivey

Chisholm-Burns

Damadzadeh

et al. 2013

Clinical Transplantation

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“…[8][9][10] Our data therefore support the inference from existing literature about disparate outcomes for black patients in the USA versus elsewhere and raises two important questions: (1) Why outcomes for black transplant patients in the USA remain inferior to white patients, and (2) Why black transplant patients in the USA have inferior outcomes in comparison with black patients outside of the USA. It could be argued that the Black population in England differs from the USA, but this is an insufficient explanation as black people in Canada and the USA share geographical origins but still have dissimilar mortality outcomes.…”

Section: Regression Analysissupporting

confidence: 81%

Do outcomes after kidney transplantation differ for black patients in England versus New York State? A comparative, population-cohort analysis

et al. 2017

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ObjectivesInferior outcomes for black kidney transplant recipients in the USA may not be generalisable elsewhere. In this population cohort analysis, we compared outcomes for black kidney transplant patients in England versus New York State.DesignRetrospective, comparative, population cohort study utilising administrative data registries.Settings and participantsEnglish data were derived from Hospital Episode Statistics, while New York State data were derived from Statewide Planning and Research Cooperative System. All adults receiving their first kidney-alone allograft between 2003 and 2013 were eligible for inclusion.MeasuresThe primary outcome measure was mortality post kidney transplantation (including inhospital death, 30-day mortality and 1-year mortality). Secondary outcome measures included postoperative admission length of stay, risk of rehospitalisation, development of cardiac events, stroke, cancer or fracture and finally transplant rejection/failure. Cox proportional hazards regression was used to investigate relationship between ethnicity, country and outcome.ResultsBlack patients comprised 6.5% of the English cohort (n=1215/18 493) and 23.0% of the New York State cohort (n=2660/11 602). Compared with New York State, black kidney transplant recipients in England were more likely younger, male, living-donor kidney recipients and had dissimilar medical comorbidities. Inpatient mortality was not statistically different, but death within 30 days, 1 year or kidney transplant rejection/failure was lower among black patients in England versus black patients in New York State. In adjusted regression analysis, with black ethnicity the reference group, white patients had reduced risk for 30-day mortality (OR 0.62 (95% CI 0.44 to 0.86)) and 1-year mortality (OR 0.79 (95% CI 0.63 to 0.99)) in New York State but no difference was observed in England. Compared with England, black kidney transplant patients in New York State had increased HR for kidney transplant rejection rejection/failure by median follow-up (HR 2.15, 95% CI 1.91 to 2.43).ConclusionsOutcomes after kidney transplantation for black patients may not be translatable between countries.

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“… 19 Twelve studies originated from the United States, 7 , 12 , 20 - 29 6 from Europe, 10 , 19 , 30 - 33 2 from Taiwan, 34 , 35 1 each from Canada, 6 North America, 9 Australia, 11 and South Africa. 36 Eight studies included adult patients (≥18 years), 6 , 7 , 10 , 11 , 20 , 30 , 32 , 35 8 studies included patients of all ages, 12 , 21 , 24 , 25 , 27 - 29 , 34 and 2 studies were restricted to pediatric patients (<21 years). 22 , 23 Six studies did not report the selected age range included.…”

Section: Resultsmentioning

confidence: 99%

“… 22 , 23 Six studies did not report the selected age range included. 9 , 19 , 26 , 31 , 33 , 36 All 24 studies assessed graft survival as an outcome; however, only 1 study censored for death, 30 13 included death in their graft survival outcome 6 , 10 - 12 , 19 - 21 , 25 , 27 , 29 , 32 - 34 while the rest of the studies did not specify. Nine studies also assessed patient survival.…”

Section: Resultsmentioning

confidence: 99%

Center Variation and the Effect of Center and Provider Characteristics on Clinical Outcomes in Kidney Transplantation: A Systematic Review of the Evidence

Tsampalieros

Knoll

Fergusson

et al. 2017

Can J Kidney Health Dis

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Background:Kidney transplantation is the best treatment option for patients with end-stage renal disease. While patient-level factors affecting survival are established, the presence of variation in the management of transplant recipients remains unknown.Objective:The objective of this study was to examine center variation in kidney transplantation and identify center and provider characteristics that may be associated with clinical outcomes.Design:This is a systematic review.Data sources:Ovid Medline, Embase, and Cochrane library from inception to June 2016 were used.Study eligibility:Any study examining the association between center or provider characteristics and graft or patient survival, quality of life, or functional status were included.Results:We identified 6327 records and 24 studies met eligibility. Most studies used data registries. Characteristics evaluated include center volume (n = 17), provider volume (n = 2), provider experience (n = 1), center type (n = 2), and location of follow-up (n = 1). Outcomes assessed included graft survival (n = 24) and patient survival (n = 9). Significant center variation was described in 12 of 15 and 5 of 7 studies for graft and patient survival. There was a significant and positive association between center volume and graft and patient survival in 8 and 2 studies, respectively. Provider experience and volume were significantly associated with less allograft loss and provider volume with lower risk of death. There was no association between graft survival and location of follow-up or center type.Limitations:There was substantial heterogeneity in the variables assessed and methodology used to analyze associations.Conclusion:This systematic review found center variation in kidney transplantation. Future studies in the current era are necessary to better evaluate this important topic.

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Poorer graft survival in ethnic minorities: results from a multi-centre UK study of kidney transplant outcomes

Cited by 11 publications

References 0 publications

Determining the effect of immunosuppressant adherence on graft failure risk among renal transplant recipients

Determining the effect of immunosuppressant adherence on graft failure risk among renal transplant recipients

Do outcomes after kidney transplantation differ for black patients in England versus New York State? A comparative, population-cohort analysis

Center Variation and the Effect of Center and Provider Characteristics on Clinical Outcomes in Kidney Transplantation: A Systematic Review of the Evidence

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