Abstract: TH-PO1160
Donor Source of Kidney Transplantation in New Zealand by Ethnicity: A Longitudinal Cohort Study
Session Information
- Transplantation: Clinical - Pretransplant Management
November 07, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 1902 Transplantation: Clinical
Authors
- Donnellan, Sine, Christchurch Hospital, Christchurch, New Zealand
- Cross, Nicholas, Christchurch Hospital, Christchurch, New Zealand
- Palmer, Suetonia, University of Otago, Christchurch, New Zealand
Background
Marked disparity is present in access to kidney transplantation based on ethnicity. We explored whether donor source for kidney transplantation in New Zealand was associated with recipient ethnicity adjusting for socioeconomic and clinical factors.
Methods
We performed a longitudinal cohort study in patients ≥18 years with ESKD who commenced kidney replacement therapy in New Zealand between 2006-2015, using ANZDATA. Deprivation score and treating centre were obtained by data linkage with the National Health Index. Primary outcomes were time to receiving first transplant (live and deceased donor) and proportion who received a pre-emptive kidney transplant. Poisson regression was performed for pre-emptive and competing risks regression for live and deceased donor transplantation (accounting for competing risks of death and alternate donor source) with 95% confidence intervals. Estimates were adjusted age, sex, smoking, deprivation, BMI, late referral, treating centre, diabetes, and coronary artery disease.
Results
Among the 5106 participants, 822 received a kidney only transplant (479 living and 343 deceased donor). Māori and Pacific patients were younger, more frequently had diabetes and referred late to specialist care, and lived in more socioeconomically deprived areas than Europeans. In European patients, 65% received a live donor kidney transplant, while the proportion was smaller for Asian (44%), Māori (44%), and Pacific (39%) patient groups. Compared to European participants, those who identified as Māori, Pacific and Asian were markedly less likely to receive a pre-emptive and live donor kidney transplant even after adjustment for socioeconomic factors, comorbidity, and referral practices (Table 1). The difference in transplantation rates between participant groups was less marked for deceased donor kidney transplantation and was not evident in Māori and Asian groups after adjustment.
Conclusion
Transplantation rates for pre-emptive and live donor transplantation but not deceased donor transplantation vary with ethnicity, socioeconomic factors and late referral to specialist services within New Zealand after adjustment for comorbidity.