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

Barraclough, Katherine A., Grace, Blair S., Lawton, Paul D. and McDonald, Stephen (2016). Residential Location and Kidney Transplant Outcomes in Indigenous Compared With Nonindigenous Australians. Transplantation,100(10):2168-2176.

Document type: Journal Article
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IRMA ID 84550754xPUB99
Title Residential Location and Kidney Transplant Outcomes in Indigenous Compared With Nonindigenous Australians
Author Barraclough, Katherine A.
Grace, Blair S.
Lawton, Paul D.
McDonald, Stephen
Journal Name Transplantation
Publication Date 2016
Volume Number 100
Issue Number 10
ISSN 0041-1337   (check CDU catalogue  open catalogue search in new window)
Scopus ID 2-s2.0-84949454006
Start Page 2168
End Page 2176
Total Pages 9
Place of Publication United States
Publisher Lippincott Williams & Wilkins
Field of Research MEDICAL AND HEALTH SCIENCES
HERDC Category C1 - Journal Article (DIISR)
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.
DOI http://dx.doi.org/10.1097/TP.0000000000001007   (check subscription with CDU E-Gateway service for CDU Staff and Students  check subscription with CDU E-Gateway in new window)
 
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Created: Tue, 26 Jul 2016, 12:38:45 CST