Renal transplantation in Indigenous Australians of the Northern Territory: closing the gap

Abstract

Chronic kidney disease causes high morbidity and mortality among Indigenous Australians of the Northern Territory (NT). Studies have shown chronic kidney disease rates of 4-10 times higher in indigenous than non-indigenous Australians and prevalent dialysis rates of 700-1200 per million population. For most patients with end-stage renal failure, renal transplantation provides the optimal treatment for people with end-stage renal disease. It reduces morbidity and mortality, and improves survival and quality of life. Graft and patient survival rates of over 80% at 5 years depending on the donor source (deceased vs living donor) are expected worldwide. However, this is not the case in Indigenous Australians of the NT where graft and patient survival are both around 50% at 5 years suggesting death with functioning graft as the most common cause of graft loss. It would provide the best treatment option for indigenous people most of who live in remote (18%) and very remote communities (63%). Many have to relocate from their communities to urban or regional centres for dialysis. Available options to avoid relocation include peritoneal dialysis, home haemodialysis and community health centre dialysis, but the acceptance rates for these are low, hence renal transplantation would provide the best option. There is evidence of identified barriers to renal transplantation for indigenous people of the NT. This review explores published data on why rates of renal transplantation in indigenous people of the NT are low and the reasons for poor outcomes highlighting possible areas of improvement.

Kidney transplant graft outcomes in 379 257 recipients on 3 continents

“…Nonwhite, non‐Asian recipients in Australia (principally Aboriginal) had significantly worse outcome than their nonwhite, non‐Asian counterpart (overwhelmingly African American) in the United States. Although it is well established that Australian Aboriginal kidney transplant recipients have worse outcomes than nonindigenous Australians and that African Americans have worse outcomes than whites in the United States, we were not able to directly compare results between Native Americans in the United States and indigenous Australians due to small sample sizes and insufficient specificity of the underlying data, respectively. Interpretation of this finding is challenging, as there are many potential differences between indigenous Australians and African Americans (eg, socioeconomics, pharmacogenomics, social systems, access to care) that may explain the disparate outcomes.…”

Heart Failure in Minority Populations - Impediments to Optimal Treatment in Australian Aborigines

“…Risk factors for CHF are also at epidemic levels where, diabetes rates are 3-10 times, obesity rates twice and renal impairment 4-10 times those of non-Indigenous Australians [63-66]. In addition alcohol consumption is excessive and rheumatic heart disease rates are among the highest in the world [31].…”

“…Key risk factors include coronary artery disease, hypertension, diabetes mellitus, obesity, rheumatic heart diseases [31], and renal impairment [66]. Pharmacokinetic differences should also be considered.…”

Satisfactory performance of the Abbott ARCHITECT i2000 tacrolimus Immunoassay against the LC-MS/MS tacrolimus assay demonstrated in kidney transplant patients from the Northern Territory, Australia

“…The positive bias could be justifiable if the drug levels are initially based and then monitored on results from the same platform. Poor transplant survival outcomes in Indigenous population of NT have been attributed to increased risk of infections and rejection (1)(2)(3)(4). Hence, these patients need very close monitoring of immunosuppression.…”