Employment status at transplant influences ethnic disparities in outcomes after deceased donor kidney transplantation

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

Research output: Contribution to journalArticlepeer-review

3 Scopus citations

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.

Original languageEnglish (US)
Article number6
JournalBMC Nephrology
Volume23
Issue number1
DOIs
StatePublished - Dec 2022
Externally publishedYes

Keywords

  • Allograft failure
  • Deceased donor kidney transplantation
  • Employment status
  • Kidney recipient mortality
  • Outcome disparity

ASJC Scopus subject areas

  • Nephrology

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