Effect of Race on Transplantation in Autosomal Dominant Polycystic Kidney Disease.

KEY POINTS

Despite overall superior outcomes, transplant outcomes of patients with autosomal dominant polycystic kidney disease are heavily influenced by race. Access to living donor and preemptive transplantation partly explains these racial disparities. Favorable Expected Post-Transplant Survival scores suggest that promoting equity would result in improved survival for patients with ADPKD.

BACKGROUND

Autosomal dominant polycystic kidney disease (ADPKD) is the most common genetic cause of ESKD and occurs without racial predilection. In general, non-White patients with ESKD have less access to transplantation, especially living donor transplantation. We examined long-term outcomes of patients with ADPKD-ESKD by self-reported race, with attention to the trajectory of Estimated Post-Transplant Survival (EPTS) scores over time.

METHODS

United Network for Organ Sharing Standard Transplant Analysis and Research files were used to identify 32,611 ADPKD transplant recipients between January 2000 and December 2022. EPTS scores were calculated from the date of waitlisting until transplantation occurred. Cumulative incidences of living and deceased transplantation were calculated and plotted. Cox models were made for graft failure and death, and a subdistribution hazards model for graft failure accounted for death as a competing outcome, with adjustment for patient, donor, and transplant factors.

RESULTS

Compared with White patients with ADPKD, all other groups had more dialysis years, more delayed graft function, and fewer living and preemptive transplants; mean EPTS scores were lower in Black and Hispanic patients at each time point on the waitlist. However, EPTS scores at the time of transplant was less likely to be <20% in Black and Hispanic patients because of longer waiting time. Black patients had a significantly higher risk of graft failure with death as competing risk compared with White patients. Asian and Hispanic patients had similar graft survivals but better patient survival compared with White patients.

CONCLUSIONS

Waitlist experience, allograft quality, and post-transplant outcomes of patients with ADPKD are influenced by patient race.