Indigenous 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.
We 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.
A 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.
KT 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.
Transplantation proceedings. 2021 Jul 07 [Epub ahead of print]
Hanna R L Wiley, Brandon M Varilek, Hector Saucedo-Crespo, Sujit Vijay Sakpal, Christopher Auvenshine, Jeffery Steers, Morgan E Nelson, Robert N Santella
Sanford School of Medicine, University of South Dakota, Sioux Falls, South Dakota., College of Nursing, Graduate Nursing, South Dakota State University, Sioux Falls, South Dakota., Transplant & Liver Surgery, Avera Medical Group, Avera McKennan Hospital & University Health Center, Sioux Falls, South Dakota; Department of Surgery, Sanford School of Medicine, University of South Dakota, Sioux Falls, South Dakota., Transplant & Liver Surgery, Avera Medical Group, Avera McKennan Hospital & University Health Center, Sioux Falls, South Dakota; Department of Surgery, Sanford School of Medicine, University of South Dakota, Sioux Falls, South Dakota; Department of Internal Medicine, Sanford School of Medicine, University of South Dakota, Sioux Falls, South Dakota., Avera Research Institute, Center for Pediatric and Community Research, Sioux Falls, South Dakota; Pediatrics, Sanford School of Medicine, University of South Dakota, Sioux Falls, South Dakota., Department of Internal Medicine, Sanford School of Medicine, University of South Dakota, Sioux Falls, South Dakota; Nephrology, Avera Medical Group, Avera McKennan Hospital & University Health Center, Sioux Falls, South Dakota. Electronic address: .