Kidney Transplant Outcomes in Indigenous People of the Northern Great Plains of the United States |
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| Affiliation: | 1. Sanford School of Medicine, University of South Dakota, Sioux Falls, South Dakota;2. College of Nursing, Graduate Nursing, South Dakota State University, Sioux Falls, South Dakota;3. Transplant & Liver Surgery, Avera Medical Group, Avera McKennan Hospital & University Health Center, Sioux Falls, South Dakota;4. Department of Surgery, Sanford School of Medicine, University of South Dakota, Sioux Falls, South Dakota;5. Department of Internal Medicine, Sanford School of Medicine, University of South Dakota, Sioux Falls, South Dakota;6. Avera Research Institute, Center for Pediatric and Community Research, Sioux Falls, South Dakota;7. Pediatrics, Sanford School of Medicine, University of South Dakota, Sioux Falls, South Dakota;8. Nephrology, Avera Medical Group, Avera McKennan Hospital & University Health Center, Sioux Falls, South Dakota;1. Emergency Department, the Third Xiangya Hospital, Central South University, Changsha, China;2. Department of Gastroenterology, Xiangya Hospital, Central South University, Changsha, China;3. Transplantation Center, the Third Xiangya Hospital, Central South University, Changsha, China;1. Department of Microbiology, Immunology, and Transplantation, Laboratory of Abdominal Transplantation, KU Leuven, Leuven, Belgium;2. Department of Abdominal Transplant Surgery, University Hospitals Leuven, Leuven, Belgium;3. Department CHROMETA, BREATHE, KU Leuven, Leuven, Belgium;4. Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium;5. Department of Rehabilitation Sciences, KU Leuven, University of Leuven, Leuven, Belgium;6. Department of Nephrology, Sint Trudo Hospital, Sint-Truiden, Belgium;7. Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium;1. Royal Free London NHS Foundation Trust, Kidney and Urology, London, UK;2. Royal Free London NHS Foundation Trust, Microbiology, London, UK;1. Department of Anesthesia and Pain Medicine, Pusan National University Yangsan Hospital, 20, Geumo-Ro, Yangsan, Republic of Korea;2. Department of Anesthesiology and Pain Medicine, Daedong Hospital, 187, Chungnyeol-Daero, Dongnae-Gu, Busan, Republic of Korea;3. Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Pusan National University Yangsan Hospital, 20, Geumo-Ro, Yangsan, Republic of Korea;4. Department of Anesthesia and Pain Medicine, School of Medicine, Pusan National University, Yangsan, Republic of Korea;1. Division of Nephrology, University of Arizona College of Medicine, Tucson, Arizona;2. Division of Endocrinology, The University of Texas Southwestern Medical Center, Dallas, Texas;3. Department of Radiology, Columbia University Medical Center, New York, New York;4. Booth School of Business, University of Chicago, Chicago, Illinois;5. Division of Nephrology, Columbia University Medical Center, New York, New York;6. Biomarkers Core Laboratory, Columbia University Medical Center, New York, New York;7. Division of Nephrology, Geisinger Medical Center, Danville, Pennsylvania;8. Department of Pediatrics, University of California San Francisco, San Francisco, California;9. Division of Nephrology, The University of Texas Southwestern Medical Center, Dallas, Texas |
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| Abstract: | BackgroundIndigenous people experience higher rates of end-stage renal disease as well as negative predictive factors that undermine kidney transplantation (KT) success. Despite these inequalities, data suggest that short-term outcomes are comparable to those of other groups, but few studies have examined this effect in the Northern Great Plains (NGP) region.MethodsWe performed a retrospective database review to determine outcomes of KT in Indigenous people of the NGP. White and Indigenous people receiving a KT between 2000 and 2018 at a single center were examined.ResultsA total of 622 KT recipients were included (117 Indigenous and 505 White). Indigenous patients were more likely to smoke, have diabetes, have higher immunologic risk, receive fewer living donor kidneys, and have longer waitlist times. In the 5 years after KT there were no significant differences in renal function, rejection events, cancer, graft failure, or patient survival. At 10 years posttransplant, Indigenous patients had twice the all-cause graft failure (odds ratio = 2.06; 95% confidence interval, 1.25–3.39) and half the survival rate (odds ratio = 0.47; 95% confidence interval, 0.29–0.76); however, this effect was not maintained once the effects of race, sex, smoking status, diabetes, preemptive transplant, high panel reactive antibody status, and transplant type were adjusted for.ConclusionsKT outcomes in Indigenous patients in the NGP region are similar to those of White patients 5 years posttransplant, with differences emerging at 10 years that could be diminished with greater emphasis on correcting modifiable risk factors. |
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