Identifying Drivers of Poor Kidney Transplant Outcomes in Indigenous Populations

The importance of social determinants in conjunction with the intractable effects of implicit bias and structural racism can scarcely be overstated regarding health outcomes, including kidney-related health. In the setting of kidney transplantation in particular, the indefensible fact that Indigenous populations experience worse access and outcomes compared with non-Indigenous groups has been well documented. With the ultimate goal of addressing structural drivers of disproportionate kidney transplant outcomes, it is important to identify potentially modifiable mechanisms or clinical mediators on which transplant providers and patients can focus their collective attention and efforts. In this issue of KI Reports, Zheng et al. report findings from a well-designed Australia and New Zealand Dialysis and Transplant registry analysis. The investigators specifically assessed acute rejection as one of the potential proximal clinical mediators of the known associations between Indigenous Australian (Aboriginal and Torres Strait Islander peoples) status and worse kidney transplant outcomes...