race, disparities, kidney transplantation, survival, hypertension, diabetes
Kidney transplantation remains the best treatment option for end-stage renal disease. However, despite overall improvements in patient and graft survival rates after kidney transplantation, differences in outcomes still exist among different racial and ethnic groups, with African-Americans having lower graft survival. Gaps continue to exist in the understanding of how demographic factors contribute to the varying outcomes among racial/ethnic groups.
We retrospectively evaluated kidney transplant outcomes in four racial/ethnic groups over a 12-year period at a large tertiary care center. Primary and secondary study outcomes were patient and graft survival across groups. To determine factors that might predict posttransplant outcomes, we analyzed both demographic and clinical variables. Descriptive statistics, Kaplan-Meier survival function and Cox regression were used for analyses.
The two most common causes of end-stage renal disease across all groups were hypertension and diabetes, accounting for 45% of the transplant recipient population. Although patient survival was similar across the four racial/ethnic groups, at 5-year follow-up, graft survival was lower for African-Americans than Caucasians (P < 0.05). Preprocedure heart failure, graft loss and hepatitis C-positive donor status were associated with lower patient survival. Female gender, hepatitis C-positive donor, smoking history, preprocedure myocardial infarction, preprocedure cerebrovascular accident and elevated serum creatinine level contributed to significant graft loss.
African-Americans have worse 5-year graft outcomes compared with Caucasians. This posttransplant outcome was multifactorial and no individual factor could be singled out to explain poorer outcomes in African-Americans. Prospective studies are needed to further delineate the causes of graft loss, and interventional studies will be needed to improve outcomes for African-American kidney transplant recipients.
Nilakantan V, Singh M, Perez RM, Shi Y, Dalmar A, Last BT, Sahajpal A. Racial disparities in outcomes following kidney transplantation: a single-center experience. J Patient Cent Res Rev. 2016;3:9-19. doi: 10.17294/2330-0698.1203