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Reasons for this disparity encompass complex interactions between donors and recipients characteristics.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>Outcomes from 3872 AA and 19,719 European American (EA) DDs who had one kidney transplanted in an AA recipient and one in an EA recipient were analyzed. Four donor\/recipient pair groups (DRP) were studied, AA\/AA, AA\/EA, EA\/AA, and EA\/EA. Survival random forests and Cox proportional hazard models were fitted to rank and evaluate modifying effects of DRP on variables associated with allograft survival. These analyses sought to identify factors contributing to the observed disparities in transplant outcomes among AA and EA DDKT recipients.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Transplant era, discharge serum creatinine, delayed graft function, and DRP were among the top predictors of allograft survival and mortality among DDKT recipients. Interaction effects between DRP with the kidney donor risk index and transplant era showed significant improvement in allograft survival over time in EA recipients. However, AA recipients appeared to have similar or poorer outcomes for DDKT performed after 2010 versus before 2001; allograft survival hazard ratios (95% CI) were 1.15 (0.74, 1.76) and 1.07 (0.8, 1.45) for AA\/AA and EA\/AA, compared to 0.62 (0.54, 0.71) and 0.5 (0.41, 0.62) for EA\/EA and AA\/EA DRP, respectively. Recipient mortality improved over time among all DRP, except unemployed AA\/AAs. Relative to DDKT performed pre-2001, employed AA\/AAs had HR\u2009=\u20090.37 (0.2, 0.69) versus 0.59 (0.31, 1.11) for unemployed AA\/AA after 2010.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>Relative to DDKT performed before 2001, similar or worse overall DCAS was observed among AA\/AAs, while EA\/EAs experienced considerable improvement regardless of employment status, KDRI, and EPTS. AA recipients of an AA DDKT, especially if unemployed, had worse allograft survival and mortality and did not appear to benefit from advances in care over the past 20\u2009years.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12882-021-02631-4","type":"journal-article","created":{"date-parts":[[2022,1,3]],"date-time":"2022-01-03T09:05:28Z","timestamp":1641200728000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Employment status at transplant influences ethnic disparities in outcomes after deceased donor kidney transplantation"],"prefix":"10.1186","volume":"23","author":[{"given":"Jasmin","family":"Divers","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sumit","family":"Mohan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"W. 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The Health Resources and Services Administration (HRSA) in the US Department of Health and Human Services provides oversight to the activities of the OPTN and SRTR contractors. Clinical and research activities are consistent with the Principles of the Declaration of Istanbul as outlined in the Declaration of Istanbul on Organ Trafficking and Transplant Tourism.The NYU Langone Institutional Review Board granted an exemption from requiring ethics approval on the ground that these analyses are conducted on de-identified data curated by the SRTR. Therefore, written consent was not required for this study based on the granted exemption.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"Wake Forest University Health Sciences and Dr. Freedman have rights to an issued United States patent related to <i>APOL1<\/i> genetic testing. In addition, Dr. Freedman receives research support from and is a consultant for AstraZeneca and RenalytixAI Pharmaceuticals. Dr. Mohan is a member of the Scientific Advisory Board for Angion Biomedica and is the deputy editor for <i>Kidney International Reports<\/i>. The other authors of this manuscript have no conflict of interest to disclose<i>.<\/i> Results presented in this paper have not been published previously in whole or part, except in abstract format.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"6"}}