Abstract
Kidney transplant outcomes of Indigenous Australians are poorer compared to non-Indigenous Australians, but it is unknown whether the type of acute rejection differs between these patient groups, or whether rejection mediates the effect between ethnicity, death-censored graft failure (DCGF) and death with a functioning graft (DWFG). Biopsy-proven acute rejection (BPAR) rates and types were compared between Indigenous and non-Indigenous recipients. The associations between ethnicity, BPAR, DCGF and DWFG were examined using adjusted competing risk analyses; and mediation analysis was conducted to determine whether BPAR mediated the adverse effects between ethnicity and outcomes. Fifty-seven (9.3%) of 616 patients who have received kidney-only transplants between 2000-2010 in Western Australia were Indigenous. Compared to non-Indigenous recipients, BPAR rates were higher in Indigenous recipients (42 vs. 74 episodes/100 recipients, p<0.01), with an excess of antibody-mediated rejections. During a median follow-up of 8-years, Indigenous recipients were more likely to experience BPAR, DCGF and DWFG compared to non-Indigenous recipients, with adjusted subdistribution hazard ratio (HR) of 1.94 (1.39, 2.70), 1.53 (0.85, 2.76; p=0.159), ...Continue Reading
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