Kidney transplantation access and outcomes for Aboriginal and Torres Strait Islander children and young adults, 1963–2020: an ANZDATA registry study

Abstract Objectives To assess differences between Aboriginal and Torres Strait Islander and non‐Indigenous Australian children and young adults in access to and outcomes of kidney transplantation. Study design A cohort study based on prospectively collected data; analysis of Australia and New Zealand Dialysis and Transplant Registry (ANZDATA) data. Setting, participants Children and young adults aged 0–24 years who commenced kidney replacement therapy in Australia during 1963–2020. Main outcome measures Proportions of children and young adults who received kidney transplants within five years of commencing dialysis; 5‐ and 10‐year death‐censored graft survival; and 5‐ and 10‐year survival of children and young adults who received kidney transplants or who remained on dialysis. Results During 1963–2020, 3736 children and young adults received kidney replacement therapy in Australia: 213 (5.8%) Aboriginal and Torres Strait Islander and 3523 (94.2%) non‐Indigenous children and young adults. During follow‐up (median, eight years; interquartile range IQR, 2.6–15 years), 2762 children and young adults received kidney transplants: 93 Aboriginal and Torres Strait Islander (43.7% of those receiving kidney replacement therapy) and 2669 non‐Indigenous children and young adults (75.8%). Smaller proportions of Aboriginal and Torres Strait Islander than of non‐Indigenous children and young adults received transplants within five years of commencing dialysis (99, 46% v 2924, 83.0%), received living donor transplants (19, 20% v 1170, 43.9%), or underwent pre‐emptive transplantation (one, 1.1% v 363, 13.6%). Five‐year graft survival for Aboriginal and Torres Strait Islander recipients was similar to non‐Indigenous recipients (61% v 75%; adjusted hazard ratio aHR, 1.43; 95% confidence interval CI, 0.02–2.05), but 10‐year graft survival was lower (35% v 61%; aHR, 1.69; 95% CI, 1.25–2.28). Five‐ and 10‐year survival after kidney transplantation was similar for Aboriginal and Torres Strait Islander and non‐Indigenous people. Among those who remained on dialysis, 10‐year survival was poorer for Aboriginal and Torres Strait Islander than non‐Indigenous children and young adults (aHR, 1.50; 95% CI, 1.08–2.10). Conclusions Five‐year graft and recipient survival were excellent for Aboriginal and Torres Strait Islander children and young adults who received kidney transplants; however, a lower proportion received transplants within five years of dialysis initiation, than non‐Indigenous children and young adults. Improving transplant access within five years of dialysis commencement should be a priority.