Identification of factors affecting access to Kidney transplant waiting list and outcomes among Indigenous Australians
Date
2021
Authors
Khanal, Namrata
Editors
Advisors
McDonald, Stephen
Cass, Alan
Lawton, Paul
Cass, Alan
Lawton, Paul
Journal Title
Journal ISSN
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Type:
Thesis
Citation
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Abstract
Improving access to the waiting list and kidney transplantation is one of the important
factors in improving poor outcomes faced by Aboriginal and Torres Strait Islanders
(Indigenous) Australians with end stage kidney disease (ESKD). This thesis was
designed to address the following specific aims:
· To identify the time to placement on the transplant waiting list and time to
transplantation among Indigenous Australians as compared to non-indigenous
Australians
· To examine predictors of placement on the transplant waiting list (and nonlisting)
for kidney transplantation utilising existing data from Australia and New
Zealand Dialysis and Transplant Registry (ANZDATA), which holds waiting list data
from the National Organ Matching System.
· To examine relationships between Indigenous patients’ facility haemodialysis
attendance and the chance of placement on the transplant waiting list,
transplantation and transplant outcomes.
· To identify risk factors predictive of good vs poor outcome following
transplantation among Indigenous recipients, through quantitative studies utilising
existing ANZDATA Registry data
Research conducted for this thesis confirmed the increased use of haemodialysis
along with low numbers of kidney transplantation among Indigenous Australians as
compared to non-indigenous Australians. Lower numbers of kidney transplant among
Indigenous Australians were further explored to find whether this related to
placement on the transplant waiting list and to define the groups who were affected
by this. A reduction in placement on the transplant waiting list among Indigenous Australians more so among people from remote areas was identified. A significant
gap in transplantation among Indigenous Australians existed in and after the second
year on the transplant waiting list. For this and other research conducted in this
thesis, remoteness was defined by Australian Bureau of Statistics (ABS) remoteness
categories, by linking ABS postcode of residence concordance data with the
postcode recorded in the ANZDATA record for the start of RRT.
Research conducted to explore the association of facility dialysis attendance in
Indigenous Australians with ESKD and placement on the transplant waiting list and
transplant outcomes was limited by the low number of outcomes measured. An
association between placement on the transplant waiting list and transplant
outcomes was not evident; however, the chance of transplantation was low among
participants with dialysis attendance ≤2.5 sessions/week.
Identification of risk factors predictive of good vs poor outcome following
transplantation among Indigenous recipients was conducted by linkage of hospitalderived
data with data from the Registry. A cohort study comparing pre and posttransplant
hospitalisation among Indigenous kidney transplant recipients of South
Australia and Northern Territory found increased rates of hospital admissions,
prolonged hospital stay, and increased rates of infection more so in the first year
post-transplant. Half of the study participants in our study cohort had delayed graft
function. Total ischaemia time was more than 16 hours in half of the study
population. Finally, a retrospective case-control study among Indigenous transplant
recipients, to explore specific risks factors in the pre-transplant period, showed
increased rates of hospitalisation to be predictive of early graft loss. No correlation
was found between other studied factors and graft loss (including patients’ death). More studies, including studies to understand pharmacokinetics and
pharmacodynamics of immunosuppression in Indigenous transplant recipients, are
required to look for other factors not examined here. Hospitalisation in the pretransplant
period needs further exploration and measures identified to reduce these
events and complications which follow. Policies need to focus in the first year posttransplant
to reduce the burden of hospitalisation. Individually tailored, evidencebased
protocols are required to improve the management of post-transplant
infections, which may include consideration of broad anti-infective agents. Finding
ways to reduce ischaemia time and delayed graft function as a result of this factor
need consideration.
Development of algorithms and outcome predicting tools taking into account pretransplant
hospitalisation into the equation may be helpful. Strategies need to be
developed to increase placement on the transplant waiting list and transplant rates.
School/Discipline
School of Population Health
Dissertation Note
Thesis (Ph.D.) -- University of Adelaide, School of Diploma of Population Health, 2020
Provenance
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