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  • Publication
    Journal Article
    Improving access to renal transplantation among Indigenous patients with end-stage renal disease: A review from the Top End of Northern Australia where graft and patient outcomes have generally been poor
    (2018-04-01)
    Dole K
    ;
    Casilli A
    ;
    ;
    Collett J
    ;
    Background: Renal transplantation would provide the best treatment option for Indigenous people of Northern Australia living in remote communities. However, the number of Indigenous Australians receiving a renal transplant is low. Poor graft and patient survival rates are common. We have observed that a significant number of patients do well. This study assessed factors contributing to the difference between those with favourable and unfavourable outcomes. Study design: We performed a descriptive case review study of 14 Indigenous Australians who received a renal transplant between 1998 and 2013. Patients were divided into favourable (graft survival >=5 years) and unfavourable outcomes groups (graft survival < 5 years). We extracted data for potential influential factors: age; gender; renal diagnosis; co-morbidities; donor; cold ischaemia time; delayed graft function; post-operative complications; rejection episodes and treatment; cancers; socio-economic status; dialysis modality and vintage; human leucocyte antigen matching; induction and maintenance immunosuppression; renal biopsies; infections and outcomes. Results: There were seven patients in each group. Those with unfavourable outcomes tended to be younger at the time of transplantation, have shorter dialysis vintage (length of time on dialysis), higher numbers of human leucocyte antigen mismatches, stronger induction immunosuppression, more episodes of rejections, more episodes of infections, delayed graft function, shorter cold ischaemia time and were from an urban environment. Conclusion: Northern Territory Indigenous Australians can do well with renal transplants. There are potential predictors for both favourable and unfavourable outcomes which can potentially be identified before listing and at the time of transplantation. Performing prospective studies with appropriate sample sizes can identify these factors.
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