Black Race Worsens Transplant Outcomes
Black race is associated with worse renal transplant outcomes among patients with lupus nephritis and focal segmental glomerulosclerosis (FSGS), according to two studies presented at Kidney Week, the annual meeting of the American Society of Nephrology.
In the one study, which involved a retrospective cohort of 150,118 patients who received their first kidney transplant from January 1995 to July 2006, Robert Nee, MD, and colleagues, of Walter Reed National Military Medical Center in Bethesda, Md., identified 4,214 recipients with lupus nephritis as the primary cause of their end-stage renal disease (ESRD).
African-American (AA) patients had a 56% increased risk of graft loss and 48% increased risk for death compared with patients of other races, after adjusting for confounding variables. At 10 years, the graft survival rate for AA was 42.9% compared with 58.2% for non-AA patients, and patient survival rate for AA was 72.2% compared with 77.4% for non-AA patients.
“Therefore, this study demonstrated that among kidney transplant recipients with ESRD due to lupus nephritis, the AA population is at increased risk for both graft loss and death as compared to the non-AA population,” Dr. Nee told Renal & Urology News. “The underlying etiology of worse transplant outcomes among AA patients remains unclear but likely involves both immunologic and nonimmunologic risk factors to include socioeconomic status, education level, access to health care, and insurance coverage.”
He also noted: “This cohort of AA patients with lupus nephritis should be considered a high risk group and deserves close monitoring in the post-transplant period. Further progress in transplant outcomes will require a multidisciplinary and holistic approach to address modification in immunosuppression regimens and to effect socioeconomic, cultural and psychosocial factors.”
In the other study, Adela D. Mattiazzi, MD, and colleagues at the University of Miami assessed 10,577 kidney transplant recipients with FSGS. The group included 6,036 Caucasian, 3,437 AA, and 1,104 Hispanic patients. Subjects were follow-up for a mean of 4.84 years. 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.
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.