Comparison of Longer-Term Outcomes After Kidney Transplantation Between Hispanic and Non-Hispanic Whites in the United States
Little is known about the longer-term kidney transplant outcomes in the rapidly growing Hispanic population. Using the United States Renal Data System, we identified 105 250 Caucasian patients who received a first kidney transplant between January 1, 1996 and December 31, 2010. We tested for differences between Hispanic and non-Hispanic patients in the outcomes of (1) mortality, (2) all-cause graft failure, and (3) graft failure excluding death with a functioning graft. We used Cox regression to estimate (with 95% confidence intervals) multivariable-adjusted cause-specific hazard ratios (aHRCS) for mortality and all-cause graft failure and subdistribution hazard ratios (aHRSD) accounting for death as a competing risk for graft failure excluding death with a functioning graft. Both mortality [aHRCS = 0.69 (0.65–0.73)] and all-cause graft failure [aHRCS = 0.79 (0.75–0.83)] were lower in Hispanics. The association between Hispanic ethnicity and graft failure excluding death was modified by age (p < 0.003). Compared with non-Hispanic whites, graft failure excluding death with a functioning graft did not differ in Hispanics aged 18–39 years [aHRSD = 0.96 (0.89–1.05)] or aged 40–59 years [aHRSD = 1.08 (1.00–1.16)], but was 13% lower in those aged ≥60 years [aHRSD = 0.87 (0.78–0.98)]. In conclusion, once accounting for differences in overall survival, better graft survival was found in older Hispanic patients, but among not those aged <60 years.
In a US registry study of over 100,000 Caucasian kidney transplant recipients, the authors show that compared with non-Hispanic recipients, those identified as Hispanic had lower mortality and all-cause graft loss, particularly Hispanic patients aged 60 years or older.