Differences in Outcome and Compliance Between Renal Transplant Patients With Migration Background and Native-Born German Patients.

Abstract

Background: Socioeconomic factors, compliance, and impaired access to the health care system are major factors influencing renal transplantation (RTx) outcome among ethnic minorities. This study investigated, for the first time in Germany, renal transplantation in patients with migration background (PMB; n = 86) and native-born German patients (n = 1180) in a single center with an observational period of January, 1997 until March, 2011. Besides numerous determinants of the RTx itself, waiting time and the RTx outcome were analyzed and, as the first study in this context, adherence to the medical regimen was assessed. Methods: The pre-, peri-, and post-transplant data of patients who underwent renal transplantation were retrieved from an electronic database (TBase 3.0) and analyzed in retrospect. Data about compliance, ancestry and origin, education, employment and language skills were assessed with a questionnaire. Results: The results show a superior outcome of PMB compared to native-born German patients concerning significantly superior graft function (creatinine, GFR) and fewer graft losses (4.7% vs. 13.2%).Equal rates of rejection with first year rejection rates of 39.5% and 35.8% in PMB and native-born German patients, respectively, with shorter rejection-free survival among PMB were demonstrated (p < 0.01). Rejections were mostly borderline changes (36.8%) and rejections graded as I (37.2%). The results show a trend to longer waiting times among PMB (median of 72 vs. 56 months, after adjustment p = 0.04). Overall mismatches, HLA-A and HLA-B mismatches were significantly greater for PMB (p < 0.05). Demographic data demonstrated a younger cohort of PMB (43 yr), compared to the group of native-born German patients (48 yr; p = 0.001). Though more PMB have an university degree, in general, education of PMB was inferior. Discussion: Despite longer waiting time on dialysis and poorer HLA-match associated with a shorter rejection-free survival, PMB population showed a superior outcome with regard to the graft function and post-transplant complications. The results were confirmed after age-adjustment. Although not completely clear, the better outcome can be explained by the better therapy adherence found in PMB group.