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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Article info
Publication history
Accepted:
December 31,
2013
Received:
June 20,
2013
Footnotes
Financial Disclosure: The authors declare that they have no relevant financial interests.
Identification
Copyright
© 2014 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
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