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Renal Transplantations in African Americans: A Single-center Experience of Outcomes and Innovations to Improve Access and Results

      Objective

      To report a single-center 10-year experience of outcomes of kidney transplantation in African Americans (AAs) vs Caucasian Americans (CA) and to propose ways in which to improve kidney transplant outcomes in AAs, increased access to kidney transplantation, prevention of kidney disease, and acceptance of organ donor registration rates in AAs.

      Methods

      We compared outcomes of deceased donor (DD) and living donor (LD) renal transplantation in AAs vs CAs in 772 recipients of first allografts at our transplant center from January 1995 to March 2004. For DD and LD transplants, no significant differences in gender, age, body mass index, or transplant panel reactive antibody (PRA) existed between AA and CA recipients.

      Results

      Primary diagnosis of hypertension was more common in AA, DD, and LD recipients. Significant differences for DD transplants included Medicaid insurance in 23% AA compared with 7.0% CA (P <.0001) and more frequent diabetes mellitus type 2 in AAs (15% vs 4.1%, P = .0009). Eighty-three percent of AAs had received hemodialysis compared with 72% of CAs (P = .02). AAs endured significantly longer pretransplant dialysis (911 ± 618 vs 682 ± 526 days CA, P = .0006) and greater time on the waiting list (972 ± 575 vs 637 ± 466 days CA, P <.0001). In DD renal transplants, AAs had more human leukocyte antigen (HLA) mismatches than CAs (4.1 ± 1.4 vs 2.7 ± 2.1, P <.0001). Mean follow-up for survivors was 7.1 ± 2.5 years. Among LD transplants, graft survival and graft function were comparable for AAs and CAs; however, among DD transplants, graft function and survival were substantially worse for AAs (P = .0003). In both LD and DD transplants, patient survival was similar for AAs and CAs.

      Conclusion

      Our data show that AAs receiving allografts from LDs have equivalent short- and long-term outcomes to CAs, but AAs have worse short- and long-term outcomes after DD transplantation. As such, we conclude that AAs should be educated about prevention of kidney disease, the importance of organ donor registration, the merits of LD over DD, and encouraged to seek LD options.
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      Linked Article

      • Editorial Comment
        UrologyVol. 84Issue 1
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          In this timely article, Modlin et al review the Cleveland Clinic's experience and outcomes of kidney transplantation in African Americans (AAs) vs Caucasian Americans (CAs) and propose several strategies to improve the results in the formal group.
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