S BATEMAN 1,2,3, O PEARSON 1,4, K OWEN 1, R TSETSAKOS 1, S MCDONALD 1,2,3, S JESUDASON 1,2,3, P CLAYTON 1,2,3
1University of Adelaide, Adelaide, Australia, 2Australian and New Zealand Dialysis and Transplant Registry, Adelaide, Australia, 3Central and Northern Adelaide Renal and Transplantation Service, Adelaide, Australia, 4Wardliparingga Aboriginal Health Research Unit, South Australian Health and Medical Research Institute, Adelaide, Australia
Aim: To establish the survival benefit of transplantation for Aboriginal and Torres Strait Islander Australians (respectfully referred to as First Nations Australians).
Background: First Nations Australians experience a disproportionate burden of kidney failure, yet receive fewer kidney transplants. The disparity in transplant outcomes between First Nations and non-Indigenous Australians has been cited as a contributing factor to this inequity. This does not inform the best treatment options for First Nations Australians living with kidney failure. Community partnerships have consistently identified transplantation as a research priority for the First Nations community.
Methods: Using the ANZDATA registry we modelled the survival benefit of transplantation for First Nations Australians aged >18 years who commenced dialysis 1/07/06-31/12/19 and were subsequently included on the kidney-only, deceased donor waitlist. Extended Cox regression models with transplantation included as a time-varying exposure compared overall patient survival of transplantation to remaining on dialysis. A secondary analysis in the general Australian population was performed to lend power to the primary analysis.
Results: We identified 401 First Nations Australians who were waitlisted for transplantation, 271 of whom received a deceased donor transplant. Transplantation conferred a significant survival benefit over remaining on dialysis after the first 12 months with a hazard ratio (HR) of 0.46 [0.23-0.93], p=0.03. This benefit was similar to that seen in the general population; HR 0.49 [0.40-0.0.59], p<0.001; interaction p=0.24.
Conclusion: Deceased donor transplantation provides a survival benefit after 12 months for Aboriginal and Torres Strait Islander Australians. These data can provide confidence in waitlisting First Nations Australians who are otherwise eligible for transplantation. Efforts to improve equity in transplantation for First Nations Australians should be prioritised.
Keywords: COVID-19 · Hematuria · Proteinuria · Acute kidney injury
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