Two groups are much more likely to have their kidney transplants fail sooner than their white counterparts: black recipients and recipients who received kidneys from Asian donors, according to new research presented at the European Society for Organ Transplantation (ESOT) Congress 2021.
The study of 20,304 kidneys transplanted between 2001 and 2015 from the U.K. National Health Service Transplant Registry suggests that the disparity is due to a combination of factors faced by ethnic minorities, including overall health.
“For a start, ethnic minority patients face significant disadvantage in access to the renal transplant waiting lists in the U.K. and may wait twice as long as white recipients for a deceased donor renal transplant, spending longer time on dialysis, so their health may have deteriorated more,” said Dr. Abdul Rahman Hakeem, a transplant surgeon at St James’s University Hospital NHS Trust, in Leeds, England.
“The longer wait for a donor kidney is due to a shortage of grafts from ethnic minority patients — in our study, Asian people make up 12.4 percent of deceased donor recipients and black people 6.7 percent of recipients, yet Asian people account for 1.6 percent of all donors and black people 1.2 percent of donors,” Hakeem said.
He said “despite efforts to improve education about transplant and organ donation amongst ethnic minority groups, awareness and donation rates remain low when compared to white people.”
“Increased deceased donation among ethnic minority communities would benefit the entire recipient pool by increasing the numbers of available organs and may specifically benefit the Asian and black recipients by increasing the numbers of blood group and [human leukocyte antigen]-compatible grafts for allocation,” said Hakeem.
Globally, the use of non-white donors for non-white recipients suggests that long-term outcomes are consistently inferior to transplants obtained from white donors, according to the study. The authors propose that the higher prevalence of diabetes, hypertension, coronary artery disease and renal disease in minority populations may contribute to inferior outcomes in those populations.
The authors found that despite advances in blood-group compatibility testing and human leukocyte antigen (HLA) matching, black recipients of black donor kidneys appear to have the poorest outcomes. More research is needed, they said.
“This difference cannot be explained by donor issues alone. There is need for future research to factor this into the U.K. kidney allocation system and get the best long-term results,” said Hakeem.
The allocation policy for organ donation after brain death changed in 2006 during the course of the study, in addition to an increasing emphasis on HLA matching. HLA molecules are found on the surface of most human cells, and matching is done before transplantation to find out if donor tissue matches recipient tissue. The study notes that this improved access to kidney transplantation among ethnic minorities.
Improved HLA tissue matches, researchers found, were better when donor and recipient pairs were the same ethnicity. At seven years after transplantation, 81 percent of white donor–recipient pairs still had a successful graft compared to 70.6 percent of Asian pairs and 69.2 percent of black pairs.
Analysis revealed graft survival outcomes were worse for black recipients who received kidneys from black donors: a 92 percent increased risk of donor organ failure compared to a white donor–white recipient pair. Asian donor–white recipient transplants had a 56 percent higher risk of donor organ failure compared to white donor–recipient pairs, and white donor–black recipient pairs had a 22 percent increased risk of donor organ failure.
Overall, donor organ survival rate after seven years was 71.9 percent from Asian donors, 74.0 percent from black donors and 80.5 percent from white donors.
According to the study, increased organ donations from deceased Asian and black donors may improve blood group and HLA matching for these recipients, however, the impact of using organs from minority donors is still poorly reported because of their relative scarcity.
“An increase in deceased organ donation from ethnic minorities may improve access to transplantation for these groups but may not improve all graft outcomes,” said Hakeem.
“Expanding the organ donor pool by increasing donation rates among ethnic minority groups remains a worthy goal and will improve overall access to transplantation whilst also reducing time spent on a waiting list, in particular within ethnic minority communities,” he said.
Edited by Judith Isacoff and Kristen Butler
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