Ethnic advantages in kidney transplant outcomes: the Hispanic Paradox at work?

Abstract

1-year survival rates surpassing 91%, long-term graft survival remains inadequate [1]. The 3-year, 5-year and 10-year deceased donor unadjusted graft survival rates are 78.6%, 67.1% and 40.8%, respectively, among all kidney recipients in the United States (USA) [2].The loss of transplanted grafts is a major public health problem. Kidney transplantation is the treatment of choice for most patients with end-stage renal disease (ESRD) since it provides a longer length of life, better quality of life [3,4] and is more cost-effective than dialysis [5,6]. When kidney grafts fail, patients return to dialysis, creating an even greater demand for scarce kidney (re-)transplants and further burdening society with greater costs [7][8][9]. Mortality rates on dialysis following a failed kidney transplant are

Does immigration background influence outcomes after renal transplantation?

“…The results from the current study, demonstrating the consistency of comparable transplant outcomes over three decades of immunosuppressive regimen, despite variable rates of LRD, clearly suggest a more complex balance of inherent risks associated with immigration by protective biological and socio-cultural factors in the Austrian immigrant population. In the U.S. literature, the observation of comparable or even improved outcomes after RTx in ethnic minority groups with Hispanic background has been called the "Hispanic paradox" [23]. As in our immigrant population, Hispanic RTx recipients were more likely to have several "protective" characteristics associated with better graft survival: younger age at RTx, more living donors, more standard criteria rather than expanded criteria donor kidneys, and more primary transplantation than re-transplantation [23].…”

“…In the U.S. literature, the observation of comparable or even improved outcomes after RTx in ethnic minority groups with Hispanic background has been called the "Hispanic paradox" [23]. As in our immigrant population, Hispanic RTx recipients were more likely to have several "protective" characteristics associated with better graft survival: younger age at RTx, more living donors, more standard criteria rather than expanded criteria donor kidneys, and more primary transplantation than re-transplantation [23]. Similar to our data, this construct clearly demonstrates that migration status results in a complex co-segregation of both risk and protective factors that are characteristic of a given immigrant cohort, but which are not easy to predict.…”

Disparities in Kidney Transplant Outcomes: A Review

“…Nonimmunologic factors identified to date include comorbidities, time on dialysis, donor characteristics, organ characteristics, socioeconomic status, medication adherence, access to care and health policies 5, 40, 57. Racial/ethnic groups have more comorbidities than whites;58, 59 and patients with comorbidities have an increased risk for all-cause mortality 35.…”

The Hispanic Epidemiological Paradox in the Fastest-Growing State in the United States

“…This research suggested that the risk of infant death among Hispanics was lower than expected compared to nonHispanic Whites, especially given the Hispanic's greater socioeconomic disadvantage. Such findings stimulated deeper and broader research that led to examining the existence of the Hispanic paradox in other areas of health besides infant mortality, such as adult morbidity and mortality, biological risk profiles, and surgical outcomes (Crimmins, Kim, Alley, Karlamangla, & Seeman, 2007;Gordon & Caicedo 2008). The literature, however, does not provide consistent evidence for the existence of the Hispanic paradox, although the evidence is stronger in the subgroup of older men who were born in Mexico (Crimmins et al, 2007;Markides & Eschbach, 2005).…”