Residential Location and Kidney Transplant Outcomes in Indigenous Compared with Nonindigenous Australians

Katherine A. Barraclough, Blair S. Grace, Paul Lawton, Stephen P. McDonald

    Research output: Contribution to journalArticleResearchpeer-review

    Abstract

    Background: Indigenous Australians experience significantly worse graft and patient outcomes after kidney transplantation compared with nonindigenous Australians. It is unclear whether rural versus urban residential location might contribute to this.

    Methods: All adult patients from the Australia and New Zealand Dialysis and Transplant Registry who received a kidney transplant in Australia between January 1, 2000, and December 31, 2012, were investigated. Patients' residential location was classified as urban (major city + inner regional) or rural (outer regional - very remote) using the Australian Bureau of Statistics Remoteness Area Classification.

    Results: Of 7826 kidney transplant recipients, 271 (3%) were indigenous. Sixty-three percent of indigenous Australians lived in rural locations compared with 10% of nonindigenous Australians (P < 0.001). In adjusted analyses, the hazards ratio for graft loss for Indigenous compared with non-Indigenous race was 1.59 (95% confidence interval [95% CI], 1.01-2.50; P = 0.046). Residential location was not associated with graft survival. Both indigenous race and residential location influenced patient survival, with an adjusted hazards ratio for death of 1.94 (95% CI, 1.23-3.05; P = 0.004) comparing indigenous with nonindigenous and 1.26 (95% CI, 1.01-1.58; P = 0.043) comparing rural with urban recipients. Five-year graft and patient survivals were 70% (95% CI, 60%-78%) and 69% (95% CI, 61%-76%) in rural indigenous recipients compared with 91% (95% CI, 90%-92%) and 92% (95% CI, 91%-93%) in urban nonindigenous recipients.

    Conclusions: Indigenous kidney transplant recipients experience worse patient and graft survival compared with nonindigenous recipients, whereas rural residential location is associated with patient but not graft survival. Of all groups, indigenous recipients residing in rural locations experienced the lowest 5-year graft and patient survivals.

    Original languageEnglish
    Pages (from-to)2168-2176
    Number of pages9
    JournalTransplantation
    Volume100
    Issue number10
    DOIs
    Publication statusPublished - 1 Oct 2016

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    Graft Survival
    Transplants
    Kidney
    Confidence Intervals
    New Zealand
    Kidney Transplantation
    Registries
    Dialysis
    Survival
    Transplant Recipients

    Cite this

    Barraclough, Katherine A. ; Grace, Blair S. ; Lawton, Paul ; McDonald, Stephen P. / Residential Location and Kidney Transplant Outcomes in Indigenous Compared with Nonindigenous Australians. In: Transplantation. 2016 ; Vol. 100, No. 10. pp. 2168-2176.
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    title = "Residential Location and Kidney Transplant Outcomes in Indigenous Compared with Nonindigenous Australians",
    abstract = "Background: Indigenous Australians experience significantly worse graft and patient outcomes after kidney transplantation compared with nonindigenous Australians. It is unclear whether rural versus urban residential location might contribute to this. Methods: All adult patients from the Australia and New Zealand Dialysis and Transplant Registry who received a kidney transplant in Australia between January 1, 2000, and December 31, 2012, were investigated. Patients' residential location was classified as urban (major city + inner regional) or rural (outer regional - very remote) using the Australian Bureau of Statistics Remoteness Area Classification. Results: Of 7826 kidney transplant recipients, 271 (3{\%}) were indigenous. Sixty-three percent of indigenous Australians lived in rural locations compared with 10{\%} of nonindigenous Australians (P < 0.001). In adjusted analyses, the hazards ratio for graft loss for Indigenous compared with non-Indigenous race was 1.59 (95{\%} confidence interval [95{\%} CI], 1.01-2.50; P = 0.046). Residential location was not associated with graft survival. Both indigenous race and residential location influenced patient survival, with an adjusted hazards ratio for death of 1.94 (95{\%} CI, 1.23-3.05; P = 0.004) comparing indigenous with nonindigenous and 1.26 (95{\%} CI, 1.01-1.58; P = 0.043) comparing rural with urban recipients. Five-year graft and patient survivals were 70{\%} (95{\%} CI, 60{\%}-78{\%}) and 69{\%} (95{\%} CI, 61{\%}-76{\%}) in rural indigenous recipients compared with 91{\%} (95{\%} CI, 90{\%}-92{\%}) and 92{\%} (95{\%} CI, 91{\%}-93{\%}) in urban nonindigenous recipients. Conclusions: Indigenous kidney transplant recipients experience worse patient and graft survival compared with nonindigenous recipients, whereas rural residential location is associated with patient but not graft survival. Of all groups, indigenous recipients residing in rural locations experienced the lowest 5-year graft and patient survivals.",
    author = "Barraclough, {Katherine A.} and Grace, {Blair S.} and Paul Lawton and McDonald, {Stephen P.}",
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    Residential Location and Kidney Transplant Outcomes in Indigenous Compared with Nonindigenous Australians. / Barraclough, Katherine A.; Grace, Blair S.; Lawton, Paul; McDonald, Stephen P.

    In: Transplantation, Vol. 100, No. 10, 01.10.2016, p. 2168-2176.

    Research output: Contribution to journalArticleResearchpeer-review

    TY - JOUR

    T1 - Residential Location and Kidney Transplant Outcomes in Indigenous Compared with Nonindigenous Australians

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    AU - Grace, Blair S.

    AU - Lawton, Paul

    AU - McDonald, Stephen P.

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    Y1 - 2016/10/1

    N2 - Background: Indigenous Australians experience significantly worse graft and patient outcomes after kidney transplantation compared with nonindigenous Australians. It is unclear whether rural versus urban residential location might contribute to this. Methods: All adult patients from the Australia and New Zealand Dialysis and Transplant Registry who received a kidney transplant in Australia between January 1, 2000, and December 31, 2012, were investigated. Patients' residential location was classified as urban (major city + inner regional) or rural (outer regional - very remote) using the Australian Bureau of Statistics Remoteness Area Classification. Results: Of 7826 kidney transplant recipients, 271 (3%) were indigenous. Sixty-three percent of indigenous Australians lived in rural locations compared with 10% of nonindigenous Australians (P < 0.001). In adjusted analyses, the hazards ratio for graft loss for Indigenous compared with non-Indigenous race was 1.59 (95% confidence interval [95% CI], 1.01-2.50; P = 0.046). Residential location was not associated with graft survival. Both indigenous race and residential location influenced patient survival, with an adjusted hazards ratio for death of 1.94 (95% CI, 1.23-3.05; P = 0.004) comparing indigenous with nonindigenous and 1.26 (95% CI, 1.01-1.58; P = 0.043) comparing rural with urban recipients. Five-year graft and patient survivals were 70% (95% CI, 60%-78%) and 69% (95% CI, 61%-76%) in rural indigenous recipients compared with 91% (95% CI, 90%-92%) and 92% (95% CI, 91%-93%) in urban nonindigenous recipients. Conclusions: Indigenous kidney transplant recipients experience worse patient and graft survival compared with nonindigenous recipients, whereas rural residential location is associated with patient but not graft survival. Of all groups, indigenous recipients residing in rural locations experienced the lowest 5-year graft and patient survivals.

    AB - Background: Indigenous Australians experience significantly worse graft and patient outcomes after kidney transplantation compared with nonindigenous Australians. It is unclear whether rural versus urban residential location might contribute to this. Methods: All adult patients from the Australia and New Zealand Dialysis and Transplant Registry who received a kidney transplant in Australia between January 1, 2000, and December 31, 2012, were investigated. Patients' residential location was classified as urban (major city + inner regional) or rural (outer regional - very remote) using the Australian Bureau of Statistics Remoteness Area Classification. Results: Of 7826 kidney transplant recipients, 271 (3%) were indigenous. Sixty-three percent of indigenous Australians lived in rural locations compared with 10% of nonindigenous Australians (P < 0.001). In adjusted analyses, the hazards ratio for graft loss for Indigenous compared with non-Indigenous race was 1.59 (95% confidence interval [95% CI], 1.01-2.50; P = 0.046). Residential location was not associated with graft survival. Both indigenous race and residential location influenced patient survival, with an adjusted hazards ratio for death of 1.94 (95% CI, 1.23-3.05; P = 0.004) comparing indigenous with nonindigenous and 1.26 (95% CI, 1.01-1.58; P = 0.043) comparing rural with urban recipients. Five-year graft and patient survivals were 70% (95% CI, 60%-78%) and 69% (95% CI, 61%-76%) in rural indigenous recipients compared with 91% (95% CI, 90%-92%) and 92% (95% CI, 91%-93%) in urban nonindigenous recipients. Conclusions: Indigenous kidney transplant recipients experience worse patient and graft survival compared with nonindigenous recipients, whereas rural residential location is associated with patient but not graft survival. Of all groups, indigenous recipients residing in rural locations experienced the lowest 5-year graft and patient survivals.

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    SN - 0041-1337

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