A Retrospective Case-Control Study Exploring Risk Factors for Loss of Kidney Transplant Function or Death Among Indigenous Transplant Recipients

Introduction: Rates of graft failure and death related to infection are substantially higher among Indigenous transplant recipients. We explored detailed risk‐factors for graft and patient survival, beyond information available from the ANZDATA Registry.

Methods: Case‐control study was conducted among indigenous transplant recipients in SA and NT 2005‐2015. Cases were those who received a kidney transplant and sustained graft loss (patient death or graft failure) within 5 years. Controls were matched (1:1) on time from transplantation and age. Medical records of participants were reviewed. Information was collected on hospital admissions and infections for 2 years pre and post kidney transplant.

Results: Of the 82 participants who met the inclusion criteria, 16 patients sustained graft loss in 2 years since transplant, and a further 7 patients within 5. 20 patients without graft loss were selected as controls. 60% participants were from NT and 40% from SA. There were 3.5 median pre‐transplant admissions per control (inter‐quartile range (IQR) 1.5, 8) and 3 (2, 6) admissions per case and 5.5 median post‐transplant admissions per control (IQR 4, 9) and 7 (2, 15) per case. Infection related admissions accounted for 83 (19.3%) admission episodes pre‐transplant and 176 (29.3%) post‐transplant. CMV PCR was positive in 11(55%) of cases and controls. BK viraemia was detected in 5 (25%) controls and 7 (30%) cases. Odds ratio (OR) for graft loss and infection related admissions were similar in cases and controls in pre‐transplant period [OR 1.0, 95% confidence interval (CI) 0.1‐7.1]and in post‐transplant period 0.7 (95% CI 0.1‐4.0).

Conclusion: This study highlights the high frequency of infection related admissions before and after transplantation. To date, these are not associated with graft and patient outcome.