Live-Donor Transplants Ease Racial Disparities in Outcomes
Charles S. Modlin, MD, Director of the Minority Men's Health Center at the institute, and colleagues studied 722 patients who underwent a primary kidney or kidney/pancreas transplant. The investigators divided subjects into two groups based on race: AA (168 patients) and non-AA (including Caucasians and Hispanics; 604 patients). Mean follow-up was 7.1 years.
AA patients had a higher proportion of deceased-donor (DD) transplants than non-AA patients (70% vs. 53%). Among all subjects who had a DD transplant, AA patients spent a significantly longer time on a transplant wait list than non-AA patients (mean 972 vs. 637 days) and had more mean HLA mismatches (4.1 vs. 2.7).
The discrepancy in HLA mismatches disappeared among LD transplant recipients. In this group, AA and Caucasian recipients had a mean 2.9 and 2.8 HLA mismatches, respectively.Among patients who had a DD transplant, a higher proportion of AA patients than non-AA patients experienced delayed graft function (48% vs. 26%).
Three- and five-year graft survival in DD kidney recipients was 74% and 62%, respectively, for AA patients, compared with 81% and 72% for non-AA patients, a significant difference between groups. Among LD kidney recipients, however, three- and five-year graft survival was similar for AA (86% and 80%, respectively,) and non-AA patients (85% and 79%). DD and LD transplant patients had similar patient survival rates at one, three, and five years.
In a separate analysis of a 440-patient subgroup, the same research team found that lower DD graft survival in AA recipients occurs despite equivalent donor allocation and immunosuppression. AA and non-AA recipients had similar clinical characteristics, but the AA group had a higher proportion of recipients on Medicaid (23% vs. 7%) and longer dialysis duration prior to transplantation (mean 911 vs. 682 days). In a multivariate analysis, AA race independently predicted graft failure, as did older age, high donor BMI, and longer duration of pretransplant dialysis.
According to the researchers, Medicaid insurance status and the number of days waiting for a transplant may be surrogate factors for socioeconomic status that are different for AA than non-AA patients. Longer duration of dialysis before transplantation compounds the impact of race on allograft survival and should be specifically targeted in programs to improve outcomes, the investigators concluded.The findings of both studies were presented at the American Transplant Congress in Boston.
In addition to Dr. Modlin, co-investigators included Ismail R. Saad, MD, Ho Yee Tiong, MD, Joan M. Alster, MS; Barbara Mastroianni, RN, MSN, Kathy Savas, RN, MSN, and Stuart M. Flechner, MD.