MCDONALD S1, OWEN K2, HUGHES J3, KHANAL N4, BATEMAN S5
1ANZDATA Registry, Adelaide, Australia, 2National Indigenous Kidney Transplant Taskforce, Adelaide, Australia, 3Menzies School of Health Research, Darwin, Australia, 4Mildura Hospital, Mildura, Australia, 5University of Adelaide, Adelaide, Australia
Background: Aboriginal and Torres Strait Islander people constituted 15% of those who commenced dialysis 2001-2019 aged <65 years, but received 5 % of deceased donor (DD) kidney transplants. Previous work showed this discrepancy is in waitlisting not allocation. Poorer outcomes among Indigenous recipients has been cited as a reason in qualitative studies.
Aim: Examine graft and patient survival among Indigenous compared with non-indigenous people
Methods: ANZDATA Australian DD1 recipients 2001-19; shared frailty Cox models adjusted for age and comorbidities
Results: Of 9244 transplant recipients, 442 were Indigenous. Median time (dialysis start to transplantation) was 3.5 years among Indigenous and 2.8 years among non-indigenous people. Indigenous recipients were on average 6 years younger, more likely to be female, smokers, and have diabetes or coronary artery disease. All significantly affected outcomes and were included in multivariate analyses.
Graft survival for all groups has improved over time. The adjusted hazard ratio (HR) for graft failure for Indigenous vs non-indigenous people transplanted 2001-2003 was 2.04 [95% CI 1.13-2.00]. This progressively fell to 0.90 [0.50-1.63] for those transplanted 2016-2019. The interaction was significant (p=0.03); HR reducing 0.98 [0.96-0.99] per year. No interaction was seen for diabetes or age. For death-censored graft survival, the initial adjusted HR of 2.1 [1.4-2.9] fell by 0.96 [0.96-1.01] per year (p=0.05). For patient survival, the adjusted HR did not significantly change (HR 1.8 [1.3-2.5] in 2001-03; 1.5 [0.8-2.6] in 2016-19. However, this interaction was not significant (p=0.2).
Conclusions: There are substantial differences in the profile of Indigenous (vs non-indigenous) transplant recipients. Historically, graft and patient outcomes for Indigenous transplant recipients were poor. Critically, this “gap” in graft (but not patient) survival in transplantation is closing.
Prof Stephen McDonald;’s substantive role is as senior staff nephrologist at the Central Northern Adelaide Renal and Transplantation Service (CNARTS). He is Director of Dialysis for CNARTS, and Clinical Director of Renal Services for Country Health SA. He is Executive Officer of the Australia and New Zealand Dialysis and Transplant Registry, and chairs the National Indigenous Kidney Transplant Taskforce.