Racial disparities and trends in kidney transplant outcomes in patients with Alport syndrome

Background: Registry data from Europe has shown an increase in age at end -stage kidney disease for patients with Alport syndrome in recent years. Whether a similar delay in transplant age has occurred in the United States for Alport patients across all racial/ethnic groups is unknown. Materials and methods: We used data from the Scien-tific Registry of Transplant Recipients (SRTR) to identify 3,794 Alport patients transplant-ed between 12/1987 and 12/2017. We di-vided the study period into five equal eras to assess temporal trends in age at transplant, graft survival, and patient survival across ra-cial groups using linear regression and Cox regression models. Results: The mean age at transplant for Blacks (28.3 years; difference (Black vs. White): 8.9 years; p < 0.0001) and Hispanics (28.7 years; difference (Hispanics vs. White): 8.7 years; p < 0.0001) was sig-nificantly younger compared with that of Whites. We observed a temporal increase in age at transplant for Whites but not for Blacks and Hispanics (p-value for interac-tion: 0.001). Black recipients were at a higher risk of graft loss (aHR: 1.78; 95% CI: 1.47, 2.15; p < 0.0001) and death (aHR: 1.73; 95% CI: 1.11, 2.69; p = 0.02) compared with White recipients. We observed significant improvements in graft survival with each successive era (p < 0.01). Temporal trends in graft survival (interaction p = 0.46) were not modified by race. Conclusion: We found ra-cial disparities in age at transplant and long-term graft survival for patients with Alport syndrome in the United States. The age at transplant increased over time for Whites but not Black and Hispanic patients.

Automated summary

There are racial disparities in age at transplant and long-term graft survival for patients with Alport syndrome in the United States. The age at transplant has increased over time for Whites, but not for Black and Hispanic patients.