Evaluating Long Term Outcomes Among Hispanic Kidney Transplant Recipients.

Rationale & Objective: Hispanics, the largest ethnic minority group in the US, experience faster progression of chronic kidney disease (CKD) to kidney failure compared to 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 to NHW.

Outcomes: Death following 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 wait-list was 18.4 months among Hispanic recipients compared to 12.7 months among NHW recipients. 28% of Hispanic recipients had private health insurance compared to 42% of NHW recipients. Hispanic recipients had a lower adjusted rates of death and the composite of allograft failure or death compared to NHW recipients (HR=0.70, 95 % CI: 0.67, 0.73, and 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, and 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 to 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.