Impact of Asian and black donor and recipient ethnicity on the outcomes after deceased donor kidney transplantation in the United Kingdom

Background Patients of Asian and black ethnicity face disadvantage on the renal transplant waiting list in the United Kingdom, because of lack of HLA and blood group matched donors from an overwhelmingly white deceased donor pool. This study evaluates outcomes of renal allografts arising from Asian and black donors. Methods The UK Transplant Registry was analysed for adult deceased donor kidney only transplants performed during January 2001-December 2015. Results Asian and black ethnicity patients constituted 12.4% and 6.7% of all deceased donor recipients but only 1.6% and 1.2% of all deceased donors, respectively. Across all recipients, and unsurprisingly given the predominantly white recipient pool, HLA matching was superior for grafts from white donors than from Asian and black donors (p<0.0001). Unadjusted survival analysis demonstrated significantly inferior long-term allograft outcomes associated with Asian and black donors, compared to white donors (7-year graft survival 71.9%, 74.0% and 80.5%; log-rank p=0.0007, respectively). On Cox regression analysis, Asian donor (HR 1.37 for Asian donors vs . white donors as baseline) and black recipient (HR 1.21 for black recipients vs . white recipient as baseline) ethnicities were associated with poorer outcomes than white counterparts, and on ethnicity matching, compared with the white donor–white recipient baseline group and adjusting for other donor and recipient factors, 5-year graft outcomes were significantly poorer for black donor-black [HR 1.92 (1.11-3.32), p=0.02], Asian donor-white recipient [HR 1.56 (1.09-2.24), p=0.016] and white donor-black recipient [HR 1.22 (1.05-1.42), p=0.011] combinations in decreasing order of worse unadjusted 5-year graft survival. Conclusions Increased deceased donation among ethnic minority communities would benefit the entire recipient pool by increasing the numbers of available organs and may specifically benefit the Asian and black recipients by increasing the numbers of blood group and HLA-compatible grafts for allocation but may not improve allograft outcomes.