Patient and allograft outcomes after kidney transplant for the Indigenous patients in the United States

PLoS One. 2021 Feb 3;16(2):e0244492. doi: 10.1371/journal.pone.0244492. eCollection 2021.

Abstract

Background: The objective is to assess cardiovascular (CV), malignancy, infectious, graft outcomes and tacrolimus levels for the Indigenous patients compared to Whites after kidney transplant (KTx).

Methods: 165 Indigenous and 165 White patients matched for the KTx year at Mayo Clinic Arizona from 2007-2015 were studied over a median follow-up of 3 years. Propensity score was calculated to account for baseline differences.

Results: Compared to Whites, Indigenous patients had the following characteristics: younger age, more obesity, diabetes, hypertension, and required dialysis prior to KTx (p<0.01). Indigenous patients had longer hospital stay for KTx, shorter follow-up and lived further from the transplant center (p<0.05). 210 (63.6%) received deceased donor KTx and more Whites received a living donor KTx compared to Indigenous patients (55.2% vs 17.6%, p<0.0001). Post-KTx, there was no difference in the CV event rates. The cumulative incidence of infectious complications was higher among the Indigenous patients (HR 1.81, p = 0.0005, 48.5% vs 38.2%, p = 0.013), with urinary causes as the most common. Malignancy rates were increased among Whites (13.3% vs 3.0%, p = 0.001) with skin cancer being the most common. There was a significant increase in the dose normalized tacrolimus level for the Indigenous patients compared to Whites at 1 months, 3 months, and 1 year post-KTx. After adjustment for the propensity score, there was no statistical difference in infectious or graft outcomes between the two groups but the mean number of emergency room visits and hospitalizations after KTx was significantly higher for Whites compared to Indigenous patients.

Conclusions: Compared to Whites, Indigenous patients have similar CV events, graft outcomes and infectious complications after accounting for baseline differences.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • American Indian or Alaska Native
  • Female
  • Follow-Up Studies
  • Graft Rejection / epidemiology*
  • Graft Rejection / prevention & control
  • Graft Survival*
  • Humans
  • Immunosuppressive Agents / therapeutic use
  • Incidence
  • Kidney Failure, Chronic / surgery*
  • Kidney Transplantation*
  • Male
  • Middle Aged
  • Propensity Score
  • Retrospective Studies
  • Treatment Outcome
  • United States
  • White People

Substances

  • Immunosuppressive Agents

Grants and funding

M.T.K received intramural funding from the Mayo Clinic Office of Healthcare Disparities Pilot Fund in 2017. The Office of Healthcare Disparities Pilot Fund was in the form of 5% time allocated throughout a calendar year for completion of the study and not in the form of a salary for any of the authors. M.T.K received the 5% time for completion of the study. Members of the Office of Healthcare Disparity at Mayo Clinic Minnesota who awarded this fund did not have any additional role in the study design, data collection and analysis, decision to publish, or preparation or review of the manuscript. Dr. Scott Leischow, coauthor on this manuscript, served as local director of the Office of Health Care Disparity at Mayo Clinic Arizona and did not participate in the application selection for this funding opportunity.