Aim: To quantify the survival benefit of kidney transplantation for Aboriginal and Torres Strait Islander Australians (respectfully referred to as Aboriginal Australians).

Background: Aboriginal Australians suffer a disproportionate burden of kidney failure. Community partnerships have consistently identified kidney transplantation as a priority for the Aboriginal community, yet rates of transplantation remain low. A perception of poorer transplant outcomes for Aboriginal Australians has been cited as a contributing factor to the inequity.  This does not inform the best treatment options for Aboriginal Australians living with kidney failure.

Methods: Through analysis of the Australian and New Zealand Dialysis and Transplant (ANZDATA) registry we modelled the survival benefit of transplantation for adult Aboriginal Australians who commenced dialysis 1/07/06-31/12/19 and were subsequently included on the kidney-only, deceased donor transplant waitlist. Extended Cox regression models with transplantation included as a time-varying exposure compared overall patient survival of transplantation to remaining on dialysis.

Results: We identified 451 Aboriginal Australians who were waitlisted for kidney transplantation, 324 of whom received a deceased donor transplant. Transplantation conferred a significant survival benefit over remaining on dialysis after the first 12 months with a hazard ratio (HR) of 0.46 [0.23-0.93], p<0.05. This benefit was similar to that seen in the general waitlisted population; HR 0.49 [0.40-0.0.59], p<0.001; interaction p=0.24.

Conclusions: Deceased donor transplantation provides a survival benefit after 12 months for Aboriginal and Torres Strait Islander Australians. These data can provide confidence in waitlisting Aboriginal Australians who are otherwise eligible for transplantation. Efforts to improve equity in transplantation for Aboriginal Australians should be prioritised.