Ethnicity matching and outcomes after kidney transplantation in the United Kingdom.
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.We undertook a retrospective, population cohort study utilising UK Transplant Registry data. The cohort comprised adult, kidney-...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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Public Library of Science (PLoS)
2018-01-01
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| Series: | PLoS ONE |
| Online Access: | http://europepmc.org/articles/PMC5898720?pdf=render |
| _version_ | 1818760184240013312 |
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| author | Bhavini Pisavadia Adam Arshad Imogen Chappelow Peter Nightingale Benjamin Anderson Jay Nath Adnan Sharif |
| author_facet | Bhavini Pisavadia Adam Arshad Imogen Chappelow Peter Nightingale Benjamin Anderson Jay Nath Adnan Sharif |
| author_sort | Bhavini Pisavadia |
| collection | DOAJ |
| description | 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.We 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.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. 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.Our 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. |
| first_indexed | 2024-12-18T06:54:35Z |
| format | Article |
| id | doaj.art-4c5ea0a5fa67476b8f0057702f5ab24f |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2024-12-18T06:54:35Z |
| publishDate | 2018-01-01 |
| publisher | Public Library of Science (PLoS) |
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| spelling | doaj.art-4c5ea0a5fa67476b8f0057702f5ab24f2022-12-21T21:17:13ZengPublic Library of Science (PLoS)PLoS ONE1932-62032018-01-01134e019503810.1371/journal.pone.0195038Ethnicity matching and outcomes after kidney transplantation in the United Kingdom.Bhavini PisavadiaAdam ArshadImogen ChappelowPeter NightingaleBenjamin AndersonJay NathAdnan SharifKidneys from non-white donors have inferior outcomes, but it is unclear if ethnicity matching between donors and recipients achieves better post kidney transplant outcomes.We 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.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. 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.Our 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.http://europepmc.org/articles/PMC5898720?pdf=render |
| spellingShingle | Bhavini Pisavadia Adam Arshad Imogen Chappelow Peter Nightingale Benjamin Anderson Jay Nath Adnan Sharif Ethnicity matching and outcomes after kidney transplantation in the United Kingdom. PLoS ONE |
| title | Ethnicity matching and outcomes after kidney transplantation in the United Kingdom. |
| title_full | Ethnicity matching and outcomes after kidney transplantation in the United Kingdom. |
| title_fullStr | Ethnicity matching and outcomes after kidney transplantation in the United Kingdom. |
| title_full_unstemmed | Ethnicity matching and outcomes after kidney transplantation in the United Kingdom. |
| title_short | Ethnicity matching and outcomes after kidney transplantation in the United Kingdom. |
| title_sort | ethnicity matching and outcomes after kidney transplantation in the united kingdom |
| url | http://europepmc.org/articles/PMC5898720?pdf=render |
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