{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,16]],"date-time":"2026-05-16T12:34:51Z","timestamp":1778934891531,"version":"3.51.4"},"reference-count":25,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,4]]},"abstract":"<jats:sec>\n            <jats:title>Background.<\/jats:title>\n            <jats:p>Kidney transplant outcomes of indigenous Australians are poorer compared with nonindigenous Australians, but it is unknown whether the type of acute rejection differs between these patient groups or whether rejection mediates the effect between ethnicity, death-censored graft failure (DCGF), and death with a functioning graft (DWFG).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods.<\/jats:title>\n            <jats:p>Biopsy-proven acute rejection (BPAR) rates and types were compared between indigenous and nonindigenous recipients. The associations between ethnicity, BPAR, DCGF, and DWFG were examined using adjusted competing risk analyses, and mediation analysis was conducted to determine whether BPAR mediated the adverse effects between ethnicity and outcomes.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results.<\/jats:title>\n            <jats:p>Fifty-seven (9.3%) of 616 patients who have received kidney-only transplants between 2000 and 2010 in Western Australia were indigenous. Compared with nonindigenous recipients, BPAR rates were higher in indigenous recipients (42 versus 74 episodes\/100 recipients, <jats:italic toggle=\"yes\">P<\/jats:italic> &lt; 0.01), with an excess of antibody-mediated rejections. During a median follow-up of 8 years, indigenous recipients were more likely to experience BPAR, DCGF, and DWFG compared with nonindigenous recipients, with adjusted subdistribution hazard ratio of 1.94 (1.39-2.70), 1.53 (0.85-2.76; <jats:italic toggle=\"yes\">P<\/jats:italic> = 0.159), and 2.14 (1.13-4.06; <jats:italic toggle=\"yes\">P<\/jats:italic> = 0.020), respectively. Although 70% of the effect between ethnicity and DCGF was mediated by BPAR, no similar association was found for DWFG.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions.<\/jats:title>\n            <jats:p>Indigenous recipients experienced poorer allograft and patient outcomes compared with nonindigenous recipients, with BPAR an important determinant for DCGF. Future research identifying other risk factors and mediators associated with patient survival in indigenous recipients should be considered a priority.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1097\/tp.0000000000002891","type":"journal-article","created":{"date-parts":[[2019,8,1]],"date-time":"2019-08-01T16:18:39Z","timestamp":1564676319000},"page":"847-855","source":"Crossref","is-referenced-by-count":8,"title":["Allograft and Patient Outcomes Between Indigenous and Nonindigenous Kidney Transplant Recipients"],"prefix":"10.1097","volume":"104","author":[{"given":"Prue","family":"Howson","sequence":"first","affiliation":[{"name":"Department of Renal Medicine, Sir Charles Gairdner Hospital, WA, Australia."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ashley B.","family":"Irish","sequence":"additional","affiliation":[{"name":"Department of Renal Medicine, Fiona Stanley Hospital, WA, Australia."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lloyd","family":"D\u2019Orsogna","sequence":"additional","affiliation":[{"name":"Department of Clinical Immunology, Fiona Stanley Hospital, WA, Australia."},{"name":"School of Medicine, University of Western Australia, Perth, Australia."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aron","family":"Chakera","sequence":"additional","affiliation":[{"name":"Department of Renal Medicine, Sir Charles Gairdner Hospital, WA, Australia."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ramyasuda","family":"Swaminathan","sequence":"additional","affiliation":[{"name":"Department of Renal Medicine, Fiona Stanley Hospital, WA, Australia."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gregory","family":"Perry","sequence":"additional","affiliation":[{"name":"Department of Renal Medicine, Royal Perth Hospital, WA, Australia."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dianne","family":"De Santis","sequence":"additional","affiliation":[{"name":"Department of Clinical Immunology, Fiona Stanley Hospital, WA, Australia."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Raelene","family":"Tolentino","sequence":"additional","affiliation":[{"name":"Western Australia Country Health Service, Aboriginal Health Strategy and Country Health Connection, WA, Australia."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Germaine","family":"Wong","sequence":"additional","affiliation":[{"name":"Sydney School of Public Health, University of Sydney, Sydney, Australia."},{"name":"Centre for Transplant and Renal Research, Westmead Hospital, Sydney, Australia."},{"name":"Centre for Kidney Research, The Children\u2019s Hospital at Westmead, Sydney, Australia."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wai H.","family":"Lim","sequence":"additional","affiliation":[{"name":"Department of Renal Medicine, Sir Charles Gairdner Hospital, WA, Australia."},{"name":"School of Medicine, University of Western Australia, Perth, Australia."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","reference":[{"key":"R2-20231002","doi-asserted-by":"crossref","first-page":"1725","DOI":"10.1056\/NEJM199912023412303","article-title":"Comparison of mortality in all patients on dialysis, patients on dialysis awaiting transplantation, and recipients of a first cadaveric transplant.","volume":"341","author":"Wolfe","year":"1999","journal-title":"N Engl J Med"},{"key":"R3-20231002","doi-asserted-by":"crossref","first-page":"882","DOI":"10.1097\/01.tp.0000232439.88527.49","article-title":"Kidney transplant outcomes in the indigenous population in the northern territory of 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