Racial disparities and trends in kidney transplant outcomes in patients with Alport syndrome

Background: Registry data from Europe has shown an increase in age at end -stage kidney disease for patients with Alport syndrome in recent years. Whether a similar delay in transplant age has occurred in the United States for Alport patients across all racial/ethnic groups is unknown. Materials and methods: We used data from the Scien-tific Registry of Transplant Recipients (SRTR) to identify 3,794 Alport patients transplant-ed between 12/1987 and 12/2017. We di-vided the study period into five equal eras to assess temporal trends in age at transplant, graft survival, and patient survival across ra-cial groups using linear regression and Cox regression models. Results: The mean age at transplant for Blacks (28.3 years; difference (Black vs. White): 8.9 years; p < 0.0001) and Hispanics (28.7 years; difference (Hispanics vs. White): 8.7 years; p < 0.0001) was sig-nificantly younger compared with that of Whites. We observed a temporal increase in age at transplant for Whites but not for Blacks and Hispanics (p-value for interac-tion: 0.001). Black recipients were at a higher risk of graft loss (aHR: 1.78; 95% CI: 1.47, 2.15; p < 0.0001) and death (aHR: 1.73; 95% CI: 1.11, 2.69; p = 0.02) compared with White recipients. We observed significant improvements in graft survival with each successive era (p < 0.01). Temporal trends in graft survival (interaction p = 0.46) were not modified by race. Conclusion: We found ra-cial disparities in age at transplant and long-term graft survival for patients with Alport syndrome in the United States. The age at transplant increased over time for Whites but not Black and Hispanic patients.