Ethnicity matching and outcomes after kidney transplantation in the United Kingdom

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.

Perioperative Vasopressors are Associated with Delayed Graft Function in Kidney Transplant Recipients in a Primarily Black and Hispanic Cohort

“…It is known that other posttransplant allograft outcomes vary between ethnic groups. 5 Black patients have been found to require higher doses and longer duration of vasopressors in other shock populations. 6 It is unknown if this is the case in kidney transplant patients.…”

Characteristics of transplant athletes competing at national and international transplant games

“…Although the predominance of white males within our TxA population is similar to previous studies9 39 the proportion of black, Asian and minority ethnic groups receiving organs in the UK was not reflected in our sample. Although we did not set out to assess ethnicity per se it is plausible that these recipients face additional health and cultural related challenges, for which participation at transplant events holds a lesser priority 40 41. Each TxA’s journey and training experience should thus be considered.…”

The relationship between donor-recipient genetic distance and long-term kidney transplant outcome

“…A recent study of donor and recipient kidney transplant pairs found that ethnically matched transplants had significantly better graft survival, when compared to non-ethnically matched pairings. However this significance disappeared when adjustment was made for clinical variables including HLA mismatch, sensitization, sex, age and cold ischaemic time 7 . Thus, the impact of shared ancestry between the kidney donor and recipient on graft outcome remains unclear.…”