Race may affect waitlisting, allograft and transplant outcomes in autosomal dominant PKD
Key takeaways:
- Black and Hispanic patients spent more years on dialysis and had delayed graft function vs. white patients.
- These groups also received fewer living and preemptive transplants than white patients.
Race may play a role in the waitlist experience, allograft quality and transplant outcomes of patients with autosomal dominant polycystic kidney disease, according to results from a cohort study.
Often marginalized groups, including Black patients with chronic kidney disease, are “less likely to experience the benefits of kidney transplantation than white patients, due to barriers and disadvantages at many of the steps between referral for transplant to post-transplant care,” Sambhavi Krishnamoorthy, MBBS, assistant professor of medicine at the University of Chicago Medicine section of nephrology, wrote with colleagues. “Patients with autosomal dominant PKD are often aware of their family histories and their risk for kidney failure and are therefore more likely to receive pre-dialysis nephrology care and obtain preemptive kidney transplants, compared to patients with other diagnoses.”
Still, the researchers added, “autosomal dominant PKD patients from under-represented minority groups experience unequal access to transplantation.”
Researchers used Standard Transplant Analysis and Research data from the United Network for Organ Sharing network to identify long-term outcomes of autosomal dominant PKD-end-stage kidney disease. The retrospective analysis included data from 32,611 patients who had kidney transplants between 2000 and 2022, focusing on estimated post-transplant survival scores by self-reported race, calculated from the date of placement on the waitlist to transplant.
The researchers also calculated the cumulative rates of transplants from living and deceased donors.
Among the patient population, 46% were women, 76% identified as non-Hispanic white, 11% were Black, 10% were Hispanic and 3% were Asian. Mean age in the group at large was 54.1 years, but investigators restricted analysis to patients 30 years of age and older to avoid potential diagnostic misclassifying of secondary disease to other hereditary cystic kidney diseases.
Median follow-up was 73 months, in which 23% of patients died and 26% had graft failure.
Findings showed Black and Hispanic patients spent more years on dialysis and had delayed graft function compared with white patients. These groups also received fewer living donations and preemptive transplants than white patients, and mean scores for estimated post-transplant survival were lower at each timepoint on the waitlist, according to the researchers.
In addition, while Black and Hispanic patients had a lower likelihood of survival scores of less than 20% at transplant, the researchers noted, this was due to longer waiting times.
Results also indicated that Black patients had a higher risk for graft failure, with death as a competing risk vs. white patients. Asian and Hispanic patients, on the other hand, had similar graft survival rates but better overall patient survival than white patients.
Compared with white patients, other groups had higher rates of human leukocyte antigen and donor-recipient mismatches, underlining a higher rate of cytomegalovirus-naïve recipients.
“In conclusion, even among patients with autosomal dominant PKD who successfully navigate a path to kidney transplantation, waitlist experience, access to living donor kidneys and post-transplant outcomes are influenced by patient race,” Krishnamoorthy and colleges wrote. “Work is needed to identify and eliminate barriers that impede timely pre-dialysis care, transplant waitlisting, and recruitment of living donors, to achieve equity for autosomal dominant PKD patients across all races and ethnicities.”
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