IMPROVEMENTS IN ACCESS TO KIDNEY TRANSPLANTATION FOR ABORIGINAL AND TORRES STRAIT ISLANDER PEOPLE
Stephen McDonald1,2,3, Katie Cundale1, Kelli Owen1,2,3, Jaqui Hughes4 1ANZDATA Registry, Adelaide, South Australia, Australia2University of Adelaide, Adelaide, South Australia, Australia3Central Adelaide Local Health Network, Adelaide, SA, Australia4Flinders University, Adelaide, SA, Australia
Abstract
Aim:
Examine changes in access to transplantation for Aboriginal and Torres Strait Islander people.
Background
Following widespread discussion, an Expert Panel was formed in 2018 and then in 2019 the National Indigenous Kidney Transplant Taskforce to address barriers to kidney transplantation for Aboriginal and Torres Strait Islander people.
Methods:
Using ANZDATA, we examined trends in waitlisting over 2012-21 among Aboriginal and Torres Strait Islander people. Comparisons used Poisson regression of the number of new transplant listings (per prevalent dialysis patient); models included a spline at 2018.
Results:
Among Aboriginal and Torres Strait Islander people in Australia, the number of incident dialysis patients has increased from 257 (in 2012) to 320 (in 2016) to 353 (in 2021). Prevalent numbers rose from 1439 (at 31Dec2012) to 1783 in 2016 and 2174 in 2021. The number waitlisted for the first time rose from 29 in 2012 to 38 in 2016 and 83 in 2021. The number of people transplanted was 21 in 2012; 34 in 2016 and 52 in 2021. Live donor transplants were 0 in 2012, 2 in 2016 and 3 in 2021.
Regression analyses show rates of waitlisting higher among males and inversely related to age. There is a significant interaction (p<0.01) with time from 2018, indicating improvement in the lower relative waitlisting rate for Aboriginal and Torres Strait Islander people although this remains low (age/gender adjusted RR 0.31(0.26-0.38) in 2021)
Conclusions:
There has been improvement in metrics around access to kidney transplantation, which coincides with the activities around the NIKTT and other programs. Although numbers waitlisted and transplanted have improved; numbers of live donor transplants remain low. Further improvement is anticipated as recommendations are implemented.
Biography
Prof McDonald is Director of Dialysis at the Central Northern Adelaide Renal and Transplantation Service, Clinical Director of Renal Services for the SA Rural Support Service and Executive Officer of the ANZDATA Registry. He Chairs the South Australian Renal Community of Practice, and the National Indigenous Kidney Transplant Taskforce. He co-chairs the Registry Special Interest Group of ACTA.
His research interests centre around the epidemiology of end-stage renal disease. Current areas of focus include how Registry data informs clinical practice; Registry based clinical trials; pregnancy among dialysis and transplant patients; and access to and outcomes of kidney transplantation among Aboriginal & Torres Strait Islander people.