Evaluating Long-Term Outcomes Among Hispanic Kidney Transplant Recipients.

RATIONALE & OBJECTIVE: Hispanics, the largest ethnic minority group in the United States, experience faster progression of chronic kidney disease (CKD) to kidney failure compared with non-Hispanic White individuals (NHW). Hispanic individuals are less likely to be referred for transplant evaluation, to be listed for transplantation, and to receive a transplant. This study compared kidney transplant outcomes between Hispanic individuals and NHW individuals to gain insights into these health disparities.

STUDY DESIGN

Retrospective cohort study.

SETTING & PARTICIPANTS: Recipients of kidney transplants between 2010 and 2021 using data from the Scientific Registry of Transplant Recipients.

EXPOSURE

Hispanic ethnicity compared with NHW.

OUTCOME

Death after transplantation and the composite of allograft failure or death.

ANALYTICAL APPROACH

Cox proportional models adjusted for donor and recipient characteristics.

RESULTS

Among 212,559 kidney allograft recipients, 17% were Hispanic, and 47% were NHW. Hispanic recipients were younger than NHW recipients (mean age, 48.8+14.1 and 53.5+14.0, respectively). The average time on the transplant waitlist was 18.4 months among Hispanic recipients compared with 12.7 months among NHW recipients. Fewer Hispanic recipients (28%) had private health insurance compared with NHW recipients (42%). Hispanic recipients had lower adjusted rates of death and the composite of allograft failure or death compared with NHW recipients (HR, 0.70 [95 % CI, 0.67-0.73]; vs HR, 0.79 [95% CI, 0.76-0.82], respectively). Similar results were observed when comparing Hispanic non-US citizen/US residents to NHW recipients (HR, 0.68 [95 % CI, 0.63-0.74]; vs HR, 0.73 [95% CI, 0.68-0.78], respectively).

LIMITATIONS

Selection bias, migration bias, salmon bias.

CONCLUSIONS

Irrespective of citizenship status, Hispanic kidney transplant recipients had lower rates of death and a composite outcome of allograft survival or death compared with NHW recipients. Future research on access to transplantation and rates of CKD progression may be warranted to improve clinical outcomes among individuals of Hispanic ethnicity with kidney disease.

PLAIN-LANGUAGE SUMMARY: Hispanic patients have a higher burden of chronic kidney disease (CKD) and faster progression to kidney failure when compared with non-Hispanic White (NHW) patients. Hispanic patients experience disparities in access to kidney care, making it harder to undergo transplantation. We evaluated outcomes after kidney transplantation in this population with the goal of gaining insights into these health disparities. We found that Hispanic kidney transplant recipients had lower rates of the composite outcome of death or kidney allograft loss compared with NHW recipients. We also observed a similar benefit in the immigrant and undocumented Hispanic population. Future research on access to transplantation and rates of CKD progression may be warranted to improve clinical outcomes among individuals of Hispanic ethnicity with kidney disease.