Black Transplant Patients with FSGS Are At Higher Risk
PHILADELPHIA—Among kidney transplant recipients with focal segmental glomerulosclerosis (FSGS), African-Americans (AA) have a greater prevalence of risk factors for allograft failure compared with other races, according to findings presented at Kidney Week 2011.
Adela D. Mattiazzi, MD, and colleagues at the University of Miami assessed 10,577 kidney transplant recipients with FSGS. The group included 6,036 Caucasians, 3,437 African-Americans, and 1,104 Hispanics. Subjects were follow-up for a mean of 4.84 years.
AA and Hispanic patients were younger than Caucasians (35, 33, and 41 years old, respectively) and received kidneys from younger donors (34, 33, and 37 years old, respectively). Deceased donors were the source of kidneys for 70% of AA patients compared with 53% of Hispanics and 52% of Caucasians. The rate of delayed graft function was significantly higher among AA than Hispanic and Caucasian recipients (22% vs. 13% and 14%, respectively), as was the rate of acute rejection (42% vs. 28%, and 31%, respectively). Allograft failure occurred in 27% of AA recipients compared with 16% among Hispanics and 17% among Caucasians.
Compared with Caucasians, AA patients had a significant 1.9 times increased risk of allograft failure in unadjusted analyses, but this increased risk became nonsignificant after adjusting for transplant era, sociodemographic factors, immunologic differences, and rejection.
Also at the conference, another research team showed that, among renal transplant recipients with end-stage renal disease (ESRD) due to lupus nephritis, AA recipients had an increased risk for graft loss and death compared with recipients of other races.
In a retrospective cohort of 150,118 patients who received their first kidney transplant from January 1, 1995 to September 29, 2006, Robert Nee, MD, of Walter Reed Army Medical Center in Washington, D.C., and colleagues identified 4,214 with lupus nephritis as the primary cause of their ESRD. African-Americans had a 41% increased risk of graft loss and 7% increased risk for death compared with patients of other races, after adjusting for confounding variables.
At 10 years, the graft survival rate for African-Americans was 42.9% compared with 58.2% for non-African-Americans.