#1101 Kidney transplantation outcomes of racial minority groups in a Central European setting: a retrospective cohort study

Abstract Background and Aims It has been previously reported that Caucasian population has superior kidney transplantation outcomes compared to other racial groups, especially in the US. Data from the Czech Republic are lacking. Method In this single centre retrospective cohort study, we analysed 2315 kidney transplant recipients between years 2014–2024 and identified 24 ethnic minority patients (Asians n = 20, African Europeans n = 4). A control group consisting of Caucasian population was established by propensity score matching in a 3:1 ratio considering recipient and donor age, recipient sex, body mass index (BMI), maximum panel-reactive antibody (PRA max), number of HLA mismatches, living donor, time on dialysis and order of transplantation. The primary endpoint was a composite of poor graft function (defined as a persistent decline in eGFR <40 ml/min/1.73 m2), graft failure, rejection and all-cause mortality at 1- and 5- years post-transplant. Secondary outcomes were individual components of primary endpoint, eGFR at 1- year post-transplant and incidence of delayed graft function. Furthermore, we compared the differences in time on dialysis prior to transplantation, time on the waiting list prior to transplantation and time from starting dialysis to being wait-listed between the racial minority group and the Caucasian population. Results There was no difference in the incidence of primary composite endpoint between the racial minority group and the Caucasian control group at 1-year (16.7 % vs. 19.4 %, respectively; P = 0.84) and 5-years post-transplant (20.8 % vs. 26.4%, respectively; P = 0.751). There was also no difference in the incidence of secondary outcomes. However, we found that the racial minority group spent longer time on dialysis before being wait-listed compared to the Caucasian population [median 1.2 years (IQR 0.9–1.9) vs. 0.8 years (IQR 0.26–1.64), respectively; P = 0.030]. Furthermore, there was also an evident trend towards longer time on dialysis prior to transplantation in the racial minority group compared to the Caucasian group [median 2.4 years IQR (1.4–4.3) vs. 1.75 years (IQR 0.74–3.3), respectively; P = 0.051] and on the waiting list prior to transplantation [median 1.2 years IQR (0.34–2.7) in racial minority group vs. median 0.56 years IQR (0.16–1.56) in Caucasian population; P = 0.094]. Conclusion In this study, kidney transplant outcomes were similar between the racial minority group and a well-matched Caucasian control group. As the Czech Republic has universal healthcare coverage, these results suggest that the previously reported discrepancies of transplantation outcomes in racial minority groups likely stem from socioeconomic factors, different healthcare coverage across countries, potential discrimination and language barrier influencing access to healthcare rather than biologic and genetic factors. However, racial minority groups are still disadvantaged by longer time on dialysis before reaching transplantation. Further study of underlying factors is necessary.