Donor Source of Kidney Transplantation in New Zealand by Ethnicity: A Longitudinal Cohort Study
1Nephrology, Canterbury District Health Board, Christchurch, New Zealand, 2Biostatistics and Computational Biology Unit, University of Otago, Christchurch, New Zealand, 3Medicine, University of Otago Christchurch, Christchurch, New Zealand
Meeting: 2019 American Transplant Congress
Abstract number: B171
Keywords: Donation, Kidney transplantation, Multivariate analysis
Session Information
Session Name: Poster Session B: Kidney Donor Selection / Management Issues
Session Type: Poster Session
Date: Sunday, June 2, 2019
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Hall C & D
*Purpose: Our aim was to explore whether donor source for kidney transplantation in New Zealand was associated with recipient ethnicity adjusting for socioeconomic and clinical factors.
*Methods: We performed a longitudinal cohort study in patients ≥18 years with end stage kidney disease who commenced renal replacement therapy (RRT) in New Zealand between 2006-2015, recorded using Australia and New Zealand Dialysis and Transplant Registry (ANZDATA). Deprivation score (NZ Dep 13) and treating centre were obtained by data linkage with the National Health Index. Primary outcomes were time to receiving first transplant (living and deceased donor) and proportion who received a pre-emptive kidney transplant. Poisson regression was performed for pre-emptive transplantation and competing risks regression for living and deceased donor transplantation (accounting for competing risks of death and alternate donor source) with 95% confidence intervals. Estimates were adjusted age, sex, smoking, deprivation, BMI, late referral, treating centre, diabetes, and coronary artery disease.
*Results: Among the 5106 participants, 822 received a kidney only transplant (479 living and 343 deceased donor). Nearly all (96.4%) of 184 pre-emptive transplants were from living donors. Māori and Pacific patients were younger, and more frequently had diabetes, referred late to specialist care, and lived in more socioeconomically deprived areas than Europeans. In European patients, 65% received a living donor kidney transplant, while the proportion was smaller for Asian (44%), Maori (44%), and Pacific (39%) patient groups. Compared to European participants, those who identified as Maori, Pacific and Asian were markedly less likely to receive a pre-emptive or living donor kidney transplant even after adjustment for socioeconomic factors, comorbidity, and referral practices (Table 1). The difference in transplantation rates between participant groups associated with ethnicity was less marked for deceased donor kidney transplantation and was not evident in Māori and Asian groups after adjustment.Table 1:
| Variable | Pre-emptive Adjusted IRR (95% CI) | Living donor Adjusted SHR (95% CI) | Deceased donor Adjusted SHR(95% CI) |
| Maori (ref: European) | 0.34(0.18-0.64) | 0.40(0.28-0.56) | 0.72(0.50-1.03) |
| Pacific (ref: European) | 0.09 (0.02-0.36) | 0.24 (0.12-0.41) | 0.60 (0.38-0.96) |
| Asian (ref: European) | 0.33 (0.16-0.68) | 0.50 (0.32-0.78) | 1.13 (0.79-1.61) |
| NZdep13 deciles 9-10 (ref: deciles 1-5) | 0.45 (0.28-0.74) | 0.56 (0.41-0.78) | 0.76 (0.54-1.06) |
| Current smoker(ref: nonsmoker) | 0.30 (0.15-0.59) | 0.37 (0.24-0.55) | 0.57 (0.39-0.85) |
| Late referral (ref: not late) | n/a | 0.66 (0.49-0.88) | 0.76 (0.58-1.02) |
| Diabetes (ref: no diabetes) | 0.26(0.14-0.47) | 0.30 (0.22-0.42) | 0.28 (0.20-0.38) |
| Coronary artery disease (ref: none) | 0.35(0.19-0.65) | 0.41 (0.28-0.62) | 0.33 (0.22-0.49) |
*Conclusions: Transplantation rates for pre-emptive and living donor transplantation are lower among patients who are non-European, have greater socioeconomic deprivation, or are referred late to specialist services in addition to comorbidity. By contrast, ethnicity (except Pacific), deprivation and referral practices did not predict access to deceased donor kidney transplantation.
To cite this abstract in AMA style:
Donnellan S, Cross N, Williman J, Palmer SC. Donor Source of Kidney Transplantation in New Zealand by Ethnicity: A Longitudinal Cohort Study [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/donor-source-of-kidney-transplantation-in-new-zealand-by-ethnicity-a-longitudinal-cohort-study/. Accessed May 11, 2025.« Back to 2019 American Transplant Congress