SP679OUTCOMES FOR KIDNEY ALLOGRAFT RECIPIENTS WITH LANGUAGE BARRIERS POST-TRANSPLANTATION - A COMPARATIVE ANALYSIS

Abstract

Introduction and Aims: Black, Asian and Minority Ethnic (BAME) patients make up an increasing number of recipients of kidney allografts in the United Kingdom. Some of these patients have poor English skills and language barriers that could contribute to health inequalities in the NHS. No study has ever compared patient and/or kidney allograft outcomes between recipients with versus without language barriers. This study aimed to test the hypothesis that non-native English speakers may have poorer outcomes after kidney transplantation compared to native English speakers. Methods: Data was extracted by our hospital informatics team for all kidney allograft recipients transplanted between 2007 and 2015. Electronic patient records were then manually searched to facilitate data linkage between various sources to create a comprehensive database of baseline demographics, donor details, clinical/biochemical parameters, histology and clinical events. Patients were linked to data held with the Language and Communication Services to identify patients who ever required interpreting services. SPSS version 22 was utilised for all statistical analysis. Results: Data was extracted for 1,140 patients who received a kidney allograft, with median follow up to 4.4 years' post-transplantation. Ethnicity breakdown of the cohort was; Caucasian (72.1%), black (5.5%), south Asian (17.6%) and other (4.7%). Interpreters had been requested for 40 kidney allograft recipients, with commonest languages required including Urdu/Punjabi (n=25), Arabic (n=2), Bengali (n=2), Gujrati (n=2) and single cases of 9 other languages. Patients who required interpreting services were more likely to be of south Asian ethnicity (80.0% of users vs 15.4% of non-users, p<0.001) and female (60.0% of users vs 39.5% of non-users, p=0.008). Comparing recipients using versus not using interpreting services, we observed less events of any rejection (2.5% vs 14.8% respectively, p=0.014), cellular rejection (2.5% vs 13.5% respectively, p=0.023) and antibody-mediated rejection (0.0% vs 3.8% respectively, p=0.217). Specifically looking at south Asians who were primary users of interpreting services, those using versus not using interpreter services had less episodes of rejection (3.1% vs 14.8% respectively, p=0.053). There was no difference between the groups for development of post-transplant diabetes, cardiac events, cerebrovascular accidents or cancer. Finally, users vs non-users of interpreting services had equal patient survival (92.5% vs 92.9% respectively, p=0.551), death-censored graft survival (90.0% vs 89.8% respectively, p=0.615) and overall graft survival (82.5% vs 84.1% respectively, p=0.461) Conclusions: Kidney allograft recipients with poor English skills who require interpreting services do not suffer adverse patient or kidney allograft outcomes compared. We observed less rejection in these patients. The major confounder to this analysis are patients who have poor English skills but do not utilise interpreting services (due to family relatives interpreting.) Despite this limitation, our results are encouraging for kidney allograft recipients who do not speak English comfortably and supports use of professional interpreting services for long-term clinical follow up post kidney transplantation to achieve suitable standard of care.