The impact of immigration background on kidney graft function (eGFR) is unknown. Italy has a publicly funded health system with universal coverage. Since immigration from non-European Union (EU) countries beyond Eastern Europe is a recent and extensive phenomenon, Italy is a rather unique setting for studying the effect of immigration status as a socioeconomic and cultural condition. We retrospectively identified all adult deceased donor kidney transplant recipients (KTRs) in Italy (2010-2015) and followed them until death, dialysis or 5-years post-transplantation; 6,346 were EU-born, 161 Eastern European-born, and 490 non-European-born. We examined changes in eGFR after 1-year post-transplant using multivariable-adjusted joint longitudinal survival random-intercept Cox-regression. Compared to EU-born KTRs, in non-European-born KTRs the adjusted average yearly eGFR decline was -0.96 mL/min/year (95% confidence interval: -1.48 to -0.45; P<0.001), whereas it was similar in Eastern European-born KTRs (+0.02 mL/min/year [-0.77 to +0.81; P =0.96]). Adjusted five-year transplant survival did not statistically differ between non-European-born, Eastern European-born and EU-born. In those surviving beyond 1-year, it was 91.8% in EU-born (87.1 to 96.8), 92.5% in Eastern European-born (86.1 to 99.4), and 89.3% in non-European-born KTRs (83.0 to 96.0). This study provides evidence that among EU KTRs, non-European immigration background is associated with eGFR decline.
Association of Immigration Background with Kidney Graft Function in a Publicly Funded Health System: A Nationwide Retrospective Cohort Study in Italy
Grossi, Alessandra Agnese;Grossi, Paolo Antonio;Picozzi, Mario;
2020-01-01
Abstract
The impact of immigration background on kidney graft function (eGFR) is unknown. Italy has a publicly funded health system with universal coverage. Since immigration from non-European Union (EU) countries beyond Eastern Europe is a recent and extensive phenomenon, Italy is a rather unique setting for studying the effect of immigration status as a socioeconomic and cultural condition. We retrospectively identified all adult deceased donor kidney transplant recipients (KTRs) in Italy (2010-2015) and followed them until death, dialysis or 5-years post-transplantation; 6,346 were EU-born, 161 Eastern European-born, and 490 non-European-born. We examined changes in eGFR after 1-year post-transplant using multivariable-adjusted joint longitudinal survival random-intercept Cox-regression. Compared to EU-born KTRs, in non-European-born KTRs the adjusted average yearly eGFR decline was -0.96 mL/min/year (95% confidence interval: -1.48 to -0.45; P<0.001), whereas it was similar in Eastern European-born KTRs (+0.02 mL/min/year [-0.77 to +0.81; P =0.96]). Adjusted five-year transplant survival did not statistically differ between non-European-born, Eastern European-born and EU-born. In those surviving beyond 1-year, it was 91.8% in EU-born (87.1 to 96.8), 92.5% in Eastern European-born (86.1 to 99.4), and 89.3% in non-European-born KTRs (83.0 to 96.0). This study provides evidence that among EU KTRs, non-European immigration background is associated with eGFR decline.
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