Employment status at transplant influences ethnic disparities in outcomes after deceased donor kidney transplantation
Abstract Background African American (AA) recipients of deceased-donor (DD) kidney transplants (KT) have shorter allograft survival than recipients of other ethnic groups. Reasons for this disparity encompass complex interactions between donors and recipients characteristics. Methods Outcomes from 3...
| Main Authors: | , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2022-01-01
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| Series: | BMC Nephrology |
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| Online Access: | https://doi.org/10.1186/s12882-021-02631-4 |
| _version_ | 1818940690501992448 |
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| author | Jasmin Divers Sumit Mohan W. Mark Brown Stephen O. Pastan Ajay K. Israni Robert S. Gaston Robert Bray Shahidul Islam Natalia V. Sakhovskaya Alejandra M. Mena-Gutierrez Amber M. Reeves-Daniel Bruce A. Julian Barry I. Freedman |
| author_facet | Jasmin Divers Sumit Mohan W. Mark Brown Stephen O. Pastan Ajay K. Israni Robert S. Gaston Robert Bray Shahidul Islam Natalia V. Sakhovskaya Alejandra M. Mena-Gutierrez Amber M. Reeves-Daniel Bruce A. Julian Barry I. Freedman |
| author_sort | Jasmin Divers |
| collection | DOAJ |
| description | Abstract Background African American (AA) recipients of deceased-donor (DD) kidney transplants (KT) have shorter allograft survival than recipients of other ethnic groups. Reasons for this disparity encompass complex interactions between donors and recipients characteristics. Methods Outcomes from 3872 AA and 19,719 European American (EA) DDs who had one kidney transplanted in an AA recipient and one in an EA recipient were analyzed. Four donor/recipient pair groups (DRP) were studied, AA/AA, AA/EA, EA/AA, and EA/EA. Survival random forests and Cox proportional hazard models were fitted to rank and evaluate modifying effects of DRP on variables associated with allograft survival. These analyses sought to identify factors contributing to the observed disparities in transplant outcomes among AA and EA DDKT recipients. Results Transplant era, discharge serum creatinine, delayed graft function, and DRP were among the top predictors of allograft survival and mortality among DDKT recipients. Interaction effects between DRP with the kidney donor risk index and transplant era showed significant improvement in allograft survival over time in EA recipients. However, AA recipients appeared to have similar or poorer outcomes for DDKT performed after 2010 versus before 2001; allograft survival hazard ratios (95% CI) were 1.15 (0.74, 1.76) and 1.07 (0.8, 1.45) for AA/AA and EA/AA, compared to 0.62 (0.54, 0.71) and 0.5 (0.41, 0.62) for EA/EA and AA/EA DRP, respectively. Recipient mortality improved over time among all DRP, except unemployed AA/AAs. Relative to DDKT performed pre-2001, employed AA/AAs had HR = 0.37 (0.2, 0.69) versus 0.59 (0.31, 1.11) for unemployed AA/AA after 2010. Conclusion Relative to DDKT performed before 2001, similar or worse overall DCAS was observed among AA/AAs, while EA/EAs experienced considerable improvement regardless of employment status, KDRI, and EPTS. AA recipients of an AA DDKT, especially if unemployed, had worse allograft survival and mortality and did not appear to benefit from advances in care over the past 20 years. |
| first_indexed | 2024-12-20T06:43:39Z |
| format | Article |
| id | doaj.art-f6e6697424884f1fa66cb4908371fbbd |
| institution | Directory Open Access Journal |
| issn | 1471-2369 |
| language | English |
| last_indexed | 2024-12-20T06:43:39Z |
| publishDate | 2022-01-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Nephrology |
| spelling | doaj.art-f6e6697424884f1fa66cb4908371fbbd2022-12-21T19:49:48ZengBMCBMC Nephrology1471-23692022-01-0123111110.1186/s12882-021-02631-4Employment status at transplant influences ethnic disparities in outcomes after deceased donor kidney transplantationJasmin Divers0Sumit Mohan1W. Mark Brown2Stephen O. Pastan3Ajay K. Israni4Robert S. Gaston5Robert Bray6Shahidul Islam7Natalia V. Sakhovskaya8Alejandra M. Mena-Gutierrez9Amber M. Reeves-Daniel10Bruce A. Julian11Barry I. Freedman12Division of Health Services Research, Department of Foundations of Medicine, NYU Long Island School of MedicineDivision of Nephrology, Department of Medicine, Columbia University College of Physicians & SurgeonsDepartment of Biostatistics and Data Sciences, Division of Public Health Sciences, Wake Forest School of MedicineRenal Division, Department of Medicine, Emory University School of MedicineDivision of Nephrology, Department of Medicine, Hennepin Healthcare, University of MinnesotaUniversity of Alabama at Birmingham School of MedicineDepartment of Pathology & Lab Medicine, Emory School of MedicineDivision of Health Services Research, Department of Foundations of Medicine, NYU Long Island School of MedicineDepartment of Internal Medicine, Section on Nephrology, Wake Forest School of MedicineDepartment of Internal Medicine, Section on Nephrology, Wake Forest School of MedicineDepartment of Internal Medicine, Section on Nephrology, Wake Forest School of MedicineUniversity of Alabama at Birmingham School of MedicineDepartment of Internal Medicine, Section on Nephrology, Wake Forest School of MedicineAbstract Background African American (AA) recipients of deceased-donor (DD) kidney transplants (KT) have shorter allograft survival than recipients of other ethnic groups. Reasons for this disparity encompass complex interactions between donors and recipients characteristics. Methods Outcomes from 3872 AA and 19,719 European American (EA) DDs who had one kidney transplanted in an AA recipient and one in an EA recipient were analyzed. Four donor/recipient pair groups (DRP) were studied, AA/AA, AA/EA, EA/AA, and EA/EA. Survival random forests and Cox proportional hazard models were fitted to rank and evaluate modifying effects of DRP on variables associated with allograft survival. These analyses sought to identify factors contributing to the observed disparities in transplant outcomes among AA and EA DDKT recipients. Results Transplant era, discharge serum creatinine, delayed graft function, and DRP were among the top predictors of allograft survival and mortality among DDKT recipients. Interaction effects between DRP with the kidney donor risk index and transplant era showed significant improvement in allograft survival over time in EA recipients. However, AA recipients appeared to have similar or poorer outcomes for DDKT performed after 2010 versus before 2001; allograft survival hazard ratios (95% CI) were 1.15 (0.74, 1.76) and 1.07 (0.8, 1.45) for AA/AA and EA/AA, compared to 0.62 (0.54, 0.71) and 0.5 (0.41, 0.62) for EA/EA and AA/EA DRP, respectively. Recipient mortality improved over time among all DRP, except unemployed AA/AAs. Relative to DDKT performed pre-2001, employed AA/AAs had HR = 0.37 (0.2, 0.69) versus 0.59 (0.31, 1.11) for unemployed AA/AA after 2010. Conclusion Relative to DDKT performed before 2001, similar or worse overall DCAS was observed among AA/AAs, while EA/EAs experienced considerable improvement regardless of employment status, KDRI, and EPTS. AA recipients of an AA DDKT, especially if unemployed, had worse allograft survival and mortality and did not appear to benefit from advances in care over the past 20 years.https://doi.org/10.1186/s12882-021-02631-4Deceased donor kidney transplantationAllograft failureKidney recipient mortalityOutcome disparityEmployment status |
| spellingShingle | Jasmin Divers Sumit Mohan W. Mark Brown Stephen O. Pastan Ajay K. Israni Robert S. Gaston Robert Bray Shahidul Islam Natalia V. Sakhovskaya Alejandra M. Mena-Gutierrez Amber M. Reeves-Daniel Bruce A. Julian Barry I. Freedman Employment status at transplant influences ethnic disparities in outcomes after deceased donor kidney transplantation BMC Nephrology Deceased donor kidney transplantation Allograft failure Kidney recipient mortality Outcome disparity Employment status |
| title | Employment status at transplant influences ethnic disparities in outcomes after deceased donor kidney transplantation |
| title_full | Employment status at transplant influences ethnic disparities in outcomes after deceased donor kidney transplantation |
| title_fullStr | Employment status at transplant influences ethnic disparities in outcomes after deceased donor kidney transplantation |
| title_full_unstemmed | Employment status at transplant influences ethnic disparities in outcomes after deceased donor kidney transplantation |
| title_short | Employment status at transplant influences ethnic disparities in outcomes after deceased donor kidney transplantation |
| title_sort | employment status at transplant influences ethnic disparities in outcomes after deceased donor kidney transplantation |
| topic | Deceased donor kidney transplantation Allograft failure Kidney recipient mortality Outcome disparity Employment status |
| url | https://doi.org/10.1186/s12882-021-02631-4 |
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