Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Sep 3;7(11):2495-2504.
doi: 10.1016/j.ekir.2022.08.027. eCollection 2022 Nov.

Acute Rejection, Overall Graft Loss, and Infection-related Deaths After Kidney Transplantation in Indigenous Australians

Catherine Zheng  1   2 , Armando Teixeira-Pinto  2   3 , Jaquelyne T Hughes  4 , Victoria Sinka  2   3 , Anita van Zwieten  2   3 , Wai H Lim  5   6 , Germaine Wong  2   3   7
Affiliations

Acute Rejection, Overall Graft Loss, and Infection-related Deaths After Kidney Transplantation in Indigenous Australians

Catherine Zheng et al. Kidney Int Rep. .

Abstract

Introduction: Aboriginal and Torres Strait Islander peoples (hereafter respectfully termed Indigenous Australians) experience a 3-fold increased risk of acute rejection after transplantation compared to non-Indigenous Australians. We investigated whether acute rejection explains the association between Indigenous status, infection-related deaths, and all-cause deaths after kidney transplantation, and whether acute rejection mediates the relationship between Indigenous status and overall graft loss.

Methods: This cohort study included all recipients who received their first kidney transplant between 2005 and 2018 in Australia, using data from the Australia and New Zealand Dialysis and Transplant registry. Multivariable Cox regression models determined the associations between Indigenous status, graft loss, infection-related deaths, and all-cause deaths. Mediation analyses examined if acute rejection mediated these relationships. Primary outcome was infection-related death. Secondary outcomes included all-cause death and overall graft loss.

Results: There were 9993 patients (n = 390 (3.9%) Indigenous Australians) who received a kidney transplant between 2005 and 2018, and they were followed-up with for 56,876 patient-years. A total of 1165 died (12%) (211 infection-related deaths) and 1957 (20%) lost their allografts. Compared with non-Indigenous recipients, the adjusted hazard ratio (HR) (95% confidence interval [CI]) for graft loss, infection-related deaths and all-cause deaths among Indigenous Australians were 2.27 (1.90-2.71), 3.01 (1.90-4.77) and 2.36 (1.89-2.94), respectively. The mediation analysis showed the association between Indigenous status and graft loss (but not infection-related death or all-cause death) was partially mediated by acute rejection (1.06 [1.03-1.09]), and the proportion of effects mediated by acute rejection was 0.10.

Conclusion: Indigenous Australians experienced a higher risk of graft loss, a relationship mediated partially through acute rejection. The higher risk of infection-related death was independent of acute rejection.

Keywords: acute rejection; health equity; indigenous; mediation analyses; transplantation.

PubMed Disclaimer

Figures

None
Graphical abstract
Figure 1
Figure 1
Directed acyclic graphs of the potential causal relationships between ethnicity and outcomes of interest (infection-related death, all-cause death and overall graft loss). (M-O confounders, mediator-outcomes confounders).
Figure 2
Figure 2
Flowchart of study participants in complete cases analyses.
Figure 3
Figure 3
Kaplan-Meier estimates of infection-related death (a), all-cause death (b) and overall graft loss (c), stratified by ethnicity
Figure 4
Figure 4
Comparison of cumulative incidence function of infection-related mortality with competing-risk of other causes of mortality stratified by ethnicity. ANZDATA, Australia and New Zealand Dialysis and Transplant Registry
See this image and copyright information in PMC

References

    1. Australian Institute of Health and Welfare The health and welfare of Australia’s Aboriginal and Torres Strait Islander peoples. 2015. https://www.aihw.gov.au/getmedia/584073f7-041e-4818-9419-39f5a060b1aa/18...
    1. Wolfe R.A., Ashby V.B., Milford E.L., et al. Comparison of mortality in all patients on dialysis, patients on dialysis awaiting transplantation, and recipients of a first cadaveric transplant. N Engl J Med. 1999;341:1725–1730. doi: 10.1056/NEJM199912023412303. - DOI - PubMed
    1. Evans R.W., Manninen D.L., Garrison L.P., Jr., et al. The quality of life of patients with end-stage renal disease. N Engl J Med. 1985;312:553–559. doi: 10.1056/NEJM198502283120905. - DOI - PubMed
    1. Khanal N., Lawton P.D., Cass A., McDonald S.P. Disparity of access to kidney transplantation by Indigenous and non-indigenous Australians. Med J Aust. 2018;209:261–266. doi: 10.5694/mja18.00304. - DOI - PubMed
    1. Cass A., Cunningham J., Snelling P., et al. Renal transplantation for Indigenous Australians: identifying the barriers to equitable access. Ethn Health. 2003;8:111–119. doi: 10.1080/13557850303562. - DOI - PubMed

LinkOut - more resources