Acute Rejection, Overall Graft Loss, and Infection-related Deaths After Kidney Transplantation in Indigenous Australians

Zheng, Catherine; Teixeira‐Pinto, Armando; Hughes, Jaquelyne T.; Sinka, Victoria; Zwieten, Anita van; Lim, Wai H.; Wong, Germaine

doi:10.1016/j.ekir.2022.08.027

Cited by 5 publications

(6 citation statements)

References 33 publications

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“…HLA mismatches are known to contribute to poorer graft outcomes 23,24 . Reasons for higher HLA mismatches among Aboriginal and Torres Strait Islander children and young adults can include lower donation rates, of both living and deceased organs from Aboriginal and Torres Strait Islander communities 25,26 . Some identified barriers to organ donation include inadequate transmission of key information to families by health professionals, hesitancy by recipients to request donation given the burden of medical conditions shared by family members, worry about its effects on donors, 27‐30 and cultural bias, as documented for adult nephrology care systems 31 .…”

Section: Discussionmentioning

confidence: 99%

Kidney transplantation access and outcomes for Aboriginal and Torres Strait Islander children and young adults, 1963–2020: an ANZDATA registry study

Chaturvedi,

Ullah,

Hughes (Wagadagam)

2024

Medical Journal of Australia

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ObjectivesTo assess differences between Aboriginal and Torres Strait Islander and non‐Indigenous Australian children and young adults in access to and outcomes of kidney transplantation.Study designA cohort study based on prospectively collected data; analysis of Australia and New Zealand Dialysis and Transplant Registry (ANZDATA) data.Setting, participantsChildren and young adults aged 0–24 years who commenced kidney replacement therapy in Australia during 1963–2020.Main outcome measuresProportions of children and young adults who received kidney transplants within five years of commencing dialysis; 5‐ and 10‐year death‐censored graft survival; and 5‐ and 10‐year survival of children and young adults who received kidney transplants or who remained on dialysis.ResultsDuring 1963–2020, 3736 children and young adults received kidney replacement therapy in Australia: 213 (5.8%) Aboriginal and Torres Strait Islander and 3523 (94.2%) non‐Indigenous children and young adults. During follow‐up (median, eight years; interquartile range [IQR], 2.6–15 years), 2762 children and young adults received kidney transplants: 93 Aboriginal and Torres Strait Islander (43.7% of those receiving kidney replacement therapy) and 2669 non‐Indigenous children and young adults (75.8%). Smaller proportions of Aboriginal and Torres Strait Islander than of non‐Indigenous children and young adults received transplants within five years of commencing dialysis (99, 46% v 2924, 83.0%), received living donor transplants (19, 20% v 1170, 43.9%), or underwent pre‐emptive transplantation (one, 1.1% v 363, 13.6%). Five‐year graft survival for Aboriginal and Torres Strait Islander recipients was similar to non‐Indigenous recipients (61% v 75%; adjusted hazard ratio [aHR], 1.43; 95% confidence interval [CI], 0.02–2.05), but 10‐year graft survival was lower (35% v 61%; aHR, 1.69; 95% CI, 1.25–2.28). Five‐ and 10‐year survival after kidney transplantation was similar for Aboriginal and Torres Strait Islander and non‐Indigenous people. Among those who remained on dialysis, 10‐year survival was poorer for Aboriginal and Torres Strait Islander than non‐Indigenous children and young adults (aHR, 1.50; 95% CI, 1.08–2.10).ConclusionsFive‐year graft and recipient survival were excellent for Aboriginal and Torres Strait Islander children and young adults who received kidney transplants; however, a lower proportion received transplants within five years of dialysis initiation, than non‐Indigenous children and young adults. Improving transplant access within five years of dialysis commencement should be a priority.

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Section: Discussionmentioning

confidence: 99%

Kidney transplantation access and outcomes for Aboriginal and Torres Strait Islander children and young adults, 1963–2020: an ANZDATA registry study

Chaturvedi,

Ullah,

Hughes (Wagadagam)

2024

Medical Journal of Australia

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“…Acute allograft rejection has previously been noted by multiple studies to be associated with subsequent graft loss [7,9,10], with factors including timing of rejection, number of acute rejection episodes, and degree of kidney function recovery after rejection treatment all afecting long-term outcomes [11]. Infections in kidney transplant recipients are also known causes of morbidity and mortality, with prior research showing that infection is the second leading cause of death in recipients with allograft function [12][13][14].…”

Section: Introductionmentioning

confidence: 99%

Impact of Early Rejection Treatment on Infection Development in Kidney Transplant Recipients: A Propensity Analysis

Gupta,

Gea-Banacloche,

Heilman

et al. 2024

Journal of Transplantation

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Introduction. The impact of renal allograft rejection treatment on infection development has not been formally defined in the literature. Methods. We conducted a retrospective cohort study of 185 rejection (case) and 185 nonrejection (control) kidney transplant patients treated at our institution from 2014 to 2020 to understand the impact of rejection on infection development. Propensity scoring was used to match cohorts. We collected data for infections within 6 months of rejection for the cases and 18 months posttransplant for controls. Results. In 370 patients, we identified 466 infections, 297 in the controls, and 169 in the cases. Urinary tract infections (38.9%) and cytomegalovirus viremia (13.7%) were most common. Cumulative incidence of infection between the case and controls was 2.17 (CI 1.54–3.05); p<0.001. There was no difference in overall survival (HR 0.90, CI 0.49–1.66) or graft survival (HR 1.27, CI 0.74–2.20) between the groups. There was a significant difference in overall survival (HR 2.28, CI 1.14–4.55; p=0.019) and graft survival (HR 1.98, CI 1.10–3.56; p=0.023) when patients with infection were compared to those without. Conclusions. As previously understood, rejection treatment is a risk factor for subsequent infection development. Our data have defined this relationship more clearly. This study is unique, however, in that we found that infections, but not rejection, negatively impacted both overall patient survival and allograft survival, likely due to our institution’s robust post-rejection protocols. Clinicians should monitor patients closely for infections in the post-rejection period and have a low threshold to treat these infections while also restarting appropriate prophylaxis.

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“…In this issue of KI Reports , Zheng et al. 7 report findings from a well-designed Australia and New Zealand Dialysis and Transplant registry analysis. The investigators specifically assessed acute rejection as one of the potential proximal clinical mediators of the known associations between Indigenous Australian (Aboriginal and Torres Strait Islander peoples) status and worse kidney transplant outcomes.…”

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confidence: 99%

“…With this unfair historical reality in mind, Zheng et al. 7 noted that 47% of the Indigenous Australian group had diabetes compared with only 18% in the non-Indigenous group. The investigators then performed the same type of mediation analysis for diabetes that they did for acute rejection.…”

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confidence: 99%

“…Zheng et al. 7 are to be commended not only for performing a well-done study but also for their thoughtful discussion and well-referenced and thorough call-to-action for investigating the deeper structural drivers of these inequities and culturally appropriate interventions. Moving forward in this direction, the recently released Caring for Australian and New Zealanders with Renal Impairment recommendations for culturally safe kidney care in First Nations Australians provide a vitally useful roadmap.…”

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confidence: 99%

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Acute Rejection, Overall Graft Loss, and Infection-related Deaths After Kidney Transplantation in Indigenous Australians

Cited by 5 publications

References 33 publications

Kidney transplantation access and outcomes for Aboriginal and Torres Strait Islander children and young adults, 1963–2020: an ANZDATA registry study

Kidney transplantation access and outcomes for Aboriginal and Torres Strait Islander children and young adults, 1963–2020: an ANZDATA registry study

Impact of Early Rejection Treatment on Infection Development in Kidney Transplant Recipients: A Propensity Analysis

Identifying Drivers of Poor Kidney Transplant Outcomes in Indigenous Populations

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