title: Roma ethnicity and clinical outcomes in kidney transplant recipients.
abstract: BACKGROUND
  Racial and ethnic disparities among North American patients with chronic kidney disease have received significant attention. In contrast, little is known about health-related outcomes of patients with end-stage renal disease among the Roma minority, also known as gypsies, compared to Caucasian individuals. We prospectively assessed the association between Roma ethnicity and long-term clinical outcomes in kidney transplant recipients.
  
  
  METHODS
  In a prevalent cohort of renal transplant recipients, followed up over a median of 94 months, we prospectively collected socio-demographic, medical (and transplant related) characteristics and laboratory data at baseline from 60 Roma and 1,003 Caucasian patients (mean age 45 (SD = 11) and 49 (SD = 13) years, 33 and 41% women, 18 and 17% with diabetes mellitus, respectively). Survival analyses examined the associations between Roma ethnicity and all-cause mortality and death-censored graft loss or death with functioning renal allograft.
  
  
  RESULTS
  During the follow-up period, 341 patients (32%) died. Two-hundred eighty (26%) patients died with a functioning graft and 201 patients (19%) returned to dialysis. After multivariable adjustments, Roma ethnicity was associated with 77% higher risk of all-cause mortality (Hazard Ratio (HR): 1.77; 95% confidence interval (CI): 1.02, 3.07), two times higher risk of mortality with functioning graft (2.04 [1.17-3.55]) and 77% higher risk of graft loss (1.77 [1.01-3.13]), respectively.
  
  
  CONCLUSIONS
  Roma ethnicity is independently associated with increased mortality risk and worse graft outcome in kidney transplant recipients. Further studies should identify the factors contributing to worse outcomes among Roma patients.
authors: Institute of Pathophysiology, Semmelweis University, 4 Nagyvarad ter, 1089 Budapest, Hungary. molnar@medformol.hu
authors: Miklos Z
authors: MZ
authors: Molnar
authors: Robert M
authors: RM
authors: Langer
authors: Adam
authors: A
authors: Remport
authors: Maria E
authors: ME
authors: Czira
authors: Katalin
authors: K
authors: Rajczy
authors: Kamyar
authors: K
authors: Kalantar-Zadeh
authors: Csaba P
authors: CP
authors: Kovesdy
authors: Marta
authors: M
authors: Novak
authors: Istvan
authors: I
authors: Mucsi
authors: Laszlo
authors: L
authors: Rosivall
mesh_terms: D000328:Adult; D005260:Female; D006085:Graft Survival; D006801:Humans; D006814:Hungary / Q000453:epidemiology; D007676:Kidney Failure, Chronic / Q000208:ethnology* / Q000401:mortality / Q000601:surgery*; D016030:Kidney Transplantation / Q000401:mortality* / Q000502:physiology; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D006178:Romani People / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D044465:White People / Q000706:statistics & numerical data