PARIS — British investigators have documented significant differences among UK ethnic minorities in the relationships between living kidney donors and their recipients.
Rishi Pruthi, MD, clinical research fellow in nephrology at the UK Renal Registry (UKRR) in Bristol, and colleagues reviewed the demographic characteristics of all living renal transplant recipients and their respective donors between 2001 and 2010 in the UK and analyzed the relationships between recipients and their donors as well as ethnicity and gender. Patient data were drawn from National Health Service (NHS) Blood and Transplant registry.
He reported the group’s findings at the 49th Congress of the European Renal Association-European Dialysis and Transplant Association (ERA-EDTA).
Renal transplantation is widely embraced as the preferred modality for renal replacement therapy in suitable patients with end-stage renal disease, with a superior quality of life and life expectancy over dialysis, Dr. Pruthi pointed out.
Ethnic minorities are disproportionately represented on the waiting list and have longer waiting times, he said. While living kidney donation is viewed as the “gold standard treatment” in terms of transplantation, it is becoming “increasingly important” given the ongoing increase in the number of patients waitlisted. In the UK alone, the number of patients on the NHS active waiting list has increased by nearly 40% over the last decade.
The present analysis included 6,580 patients and their respective donors.
Results showed that while ethnic minorities accounted for 1,760 (26.2%) patients on the current transplant waiting list, within the study group ethnic minorities received significantly fewer transplants in comparison – with Asians receiving only 471 (7.2%) transplants and blacks receiving 244 (3.7%) transplants.
Most living kidney recipients were men. Of 6,580 living kidney recipients, 2,640 (40.1%) were women and 3,940 (59.9%) were men. In the Asian population, the male-to-female imbalance was most pronounced, with 30.8% of living kidneys in this ethnic group being allocated to women and 69.2% to men. Among donors, women donated more than men across all ethnic groups except within the black population where “intriguingly” this trend was reversed with men actually donating more often (54%).
Spousal living kidney donation rates were similar in white (23.8%) and Asian (21.7%) populations but significantly lower in blacks (13.5%). Among spouses, females were more likely to donate to their spouses than the contrary, with the gender gap being most pronounced in the Asian population. For Asian couples, 79.4% of spousal donations were from wives to their husbands compared to 60.6% and 61.4% of blacks and whites, respectively.
The analysis showed no gender disparity for offspring donation to their parents regardless of ethnicity. Notably, male and female children of all ethnicities were equally likely to donate to either parent. The researchers also documented a boost in the number of donations from relationships other than spouses or offspring including uncles, aunts, friends, etc.
Living kidney donation occurs less frequently than expected, and is subject to significant relationship differences within ethnic minorities, Dr. Pruthi said.
He added that more research is needed to explain the relationship and ethnic differences that drive living kidney donations. The findings would hopefully, in turn, set the stage for developing strategies to increase donation rates in ethnic minorities, especially from male spouses.
By Jill Stein
Jill Stein is a Paris-based freelance medical writer.