Outcomes among Hispanic Kidney Transplant Recipients Including Non-US Citizens

Background: Hispanics experience a faster progression of CKD to kidney failure compared to non-Hispanic Whites (NHW). They are also less likely to receive pre-dialysis nephrology care, be referred for transplant evaluation, be listed for transplant, and receive a transplant. This study compares transplant outcomes between Hispanic individuals and NHW, to demonstrate the benefit of increasing access to transplantation to this patient population. Methods: We evaluated kidney transplant recipients from 2010-2021 using the SRTR data. For the main outcomes we compared time to post-transplant patient mortality and graft failure between Hispanic and NHW recipients using Cox proportional models adjusted for donor and recipient characteristics. Results: Among 212,559 kidney recipients, 17% were Hispanic and 47% were NHW. Among Hispanics, 27.5% were non-US citizens. Hispanic recipients were younger than NHW recipients (mean age 48.8+14.1 vs. 53.5+14.0). The average wait list months for Hispanics was 18.4 compared to 12.7 for NHW recipients. 28% of Hispanics had private health insurance compared to 42% of NHW. In adjusted models, Hispanics had a lower HR of death and graft failure compared to NHW recipients (HR=0.70, 95 % CI: 0.67, 0.73, and HR=0.79, 95% CI: 0.76, 0.82, respectively). We found similar results when comparing Hispanic non-US citizens to NHW recipients (HR=0.68, 95 % CI: 0.63, 0.74, and HR=0.73, 95% CI: 0.68, 0.78; Figure 1). Conclusion: Despite many social and economic challenges and irrespective of citizenship status, Hispanic transplant recipients had a lower HR of death and better graft survival compared to NHW transplant recipients. Future studies that focus on reducing disparities throughout the transplant process and improve access to transplantation in this population are warranted.