Abstract
BackgroundKidneys from non-white donors have inferior outcomes, but it is unclear if ethnicity matching between donors and recipients achieves better post kidney transplant outcomes.MethodsWe undertook a retrospective, population cohort study utilising UK Transplant Registry data. The cohort comprised adult, kidney-alone, transplant recipients receiving their first kidney transplant between 2003–2015, with data censored at 1st October 2016. We included 27,970 recipients stratified into white (n = 23,215), black (n = 1,679) and south Asian (n = 3,076) ethnicity, with median post-transplant follow-up of 1,676 days (IQR 716–2,869 days). Unadjusted and adjusted Cox regression survival analyses were performed to investigate ethnicity effect on risk for graft loss and mortality.ResultsIn unadjusted analyses, matched ethnicity between donors-recipients resulted in better outcomes for delayed graft function, one-year creatinine, graft and patient survival but these differed by ethnicity matches. Compared to white-to-white transplants, risk for death-censored graft loss was higher in black-to-black and similar among Asian-to-Asian transplants, but mortality risk was lower for both black-to-black and Asian-to-Asian transplants. In Cox regression models, compared to white donors, we observed higher risk for graft loss with both south Asian (HR 1.38, 95%CI 1.12–1.70, p = 0.003) and black (HR 1.66, 95%CI 1.30–2.11, p<0.001) donated kidneys independent of recipient ethnicity. We observed no mortality difference with south Asian donated kidneys but increased mortality with black donated kidneys (HR 1.68, 95%CI 1.21–2.35, p = 0.002). Matching ethnicities made no significant difference in any Cox regression model. Similar results were observed after stratifying our analysis by living and deceased-donor kidney transplantation.ConclusionsOur data confirm inferior outcomes associated with non-white kidney donors for kidney transplant recipients of any ethnicity in a risk-adjusted model for the United Kingdom population. However, contrary to non-renal transplant literature, we did not identify any survival benefits associated with donor-recipient ethnicity matching.
Highlights
Minority ethnics in the United Kingdom comprise a third of patients on the national deceased-donor kidney waiting list and have longer waits for an adult kidney transplant; median wait of 1070 days and 1134 days (Blacks) compared to 882 days (Whites) [1]
In unadjusted analyses, matched ethnicity between donors-recipients resulted in better outcomes for delayed graft function, one-year creatinine, graft and patient survival but these differed by ethnicity matches
In Cox regression models, compared to white donors, we observed higher risk for graft loss with both south Asian (HR 1.38, 95%CI 1.12–1.70, p = 0.003) and black (HR 1.66, 95%CI 1.30– 2.11, p
Summary
Minority ethnics in the United Kingdom comprise a third of patients on the national deceased-donor kidney waiting list and have longer waits for an adult kidney transplant; median wait of 1070 days (south Asians) and 1134 days (Blacks) compared to 882 days (Whites) [1]. Biological differences between ethnic groups, such as disparate frequencies of different blood groups and particular combinations of HLA alleles, contributes to these prolonged waiting time as minority ethnic recipients are waiting to receive kidney allografts from a predominantly white deceased donor organ pool. While this delay can be overcome with a suitable live kidney donor, this may not be available for all kidney transplant candidates. Data from the kidney transplantation literature is limited but Locke and colleagues recently published data suggesting kidneys donated after cardiac (but not brain) death from Black donors were associated with the best patient and graft survival for Black recipients [5]. Kidneys from non-white donors have inferior outcomes, but it is unclear if ethnicity matching between donors and recipients achieves better post kidney transplant outcomes
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