Renal transplantation in indigenous Australians of the Northern Territory: closing the gap

Abstract

Chronic kidney disease causes high morbidity and mortality among Indigenous Australians of the Northern Territory (NT). Studies have shown chronic kidney disease rates of 4-10 times higher in indigenous than non-indigenous Australians and prevalent dialysis rates of 700-1200 per million population. For most patients with end-stage renal failure, renal transplantation provides the optimal treatment for people with end-stage renal disease. It reduces morbidity and mortality, and improves survival and quality of life. Graft and patient survival rates of over 80% at 5 years depending on the donor source (deceased vs living donor) are expected worldwide. However, this is not the case in Indigenous Australians of the NT where graft and patient survival are both around 50% at 5 years suggesting death with functioning graft as the most common cause of graft loss. It would provide the best treatment option for indigenous people most of who live in remote (18%) and very remote communities (63%). Many have to relocate from their communities to urban or regional centres for dialysis. Available options to avoid relocation include peritoneal dialysis, home haemodialysis and community health centre dialysis, but the acceptance rates for these are low, hence renal transplantation would provide the best option. There is evidence of identified barriers to renal transplantation for indigenous people of the NT. This review explores published data on why rates of renal transplantation in indigenous people of the NT are low and the reasons for poor outcomes highlighting possible areas of improvement.

Keywords: Indigenous Australian; chronic kidney disease; infection; outcome; rejection; renal transplantation.