Transplantation. 98(9):974-978, November 15, 2014.
Defining those factors that determine the outcomes of patients following organ transplantation is important for many reasons, not least to inform where interventions to improve outcomes should be targeted. There are many donor and recipient factors that have been identified which are associated with better outcomes and these have led to a variety of interventions. Factors that predict graft and patient survival do not necessarily coincide. Laging and colleagues undertook a retrospective analysis of outcomes of just over 1300 kidney allograft recipients in the Netherlands to determine the impact of socioeconomic factors ad ethnicity on outcomes. Other than the usual expected variables (such as recipient age, PRA, mismatch, donor type and CNI treatment for graft survival, and recipient age, co-morbidities, year of transplant and donor type for patient survival), the authors found no impact on either socioeconomic factors or ethnicity on either patient or graft survival.
These findings are somewhat unexpected since other studies elsewhere, notably the US, have shown that both socioeconomic status and ethnicity are associated with outcome. Reasons for this difference are not clear: they might relate to the methodology and use of postcode to generate surrogate data, the inevitable limitations associated with use of national registry data and the relatively small numbers might explain the lack of an effect or there selection bias consequent on socioeconomic deprivation could deny access to transplantation. These explanations, however, are not fully convincing and other explanations are worthy of consideration. The national social fabric and access to health care are also likely to have a significant impact on both patient and graft outcome. As always, prospective studies to test these hypotheses would be helpful but this study should induce some reflection as to the possible impact of social fabric on health care and how clinicians can help ensure an equitable access to care.