1. A Contemporary Analysis of Outcomes and Modifiable Risk Factors of Ethnic Disparities in Kidney Transplantation.
- Author
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Wilkins LJ, Nyame YA, Gan V, Lin S, Greene DJ, Flechner SM, and Modlin CS
- Subjects
- Diabetes Mellitus enzymology, Female, Graft Survival, Humans, Immunosuppressive Agents therapeutic use, Living Donors statistics & numerical data, Male, Medication Adherence statistics & numerical data, Middle Aged, Retrospective Studies, Risk Factors, Survival Rate, Treatment Outcome, Black or African American statistics & numerical data, Graft Rejection ethnology, Health Status Disparities, Kidney Transplantation statistics & numerical data, White People statistics & numerical data
- Abstract
Objective: The aim of this study was to provide a contemporary analysis of longitudinal kidney transplant outcomes and to evaluate potential causes of ethnic disparities among African American (AA) and Caucasian American (CA) patients undergoing kidney transplantation at our institution., Patients and Methods: 1400 patients were identified who underwent kidney transplantation from 2003 to 2013 from a large, academic institution in Cleveland, OH. Relevant recipient and donor demographic and clinical covariates were obtained from an institutional transplant database. Simple descriptive statistics and comparative survival analyses were performed to assess overall survival and graft survival., Results: The final cohort was comprised of 341 AA and 1059 CA patients. AAs were less likely to receive a living donor transplant (27.6% vs. 57.2%, p < 0.001) compared to CAs. Overall patient survival did not significantly differ between the two groups even when stratified by ethnicity. However, AAs had a significantly lower rate of graft survival (p < 0.001). On stratified analysis, there was no difference in the rate of graft survival among AAs and CAs who received living donor grafts. On univariate analysis, AAs demonstrated higher rates of immunosuppression non-compliance and chronic rejection (both p < 0.05). On multivariate analysis, AA recipient ethnicity (HR 1.56, p = 0.047), recipient history of diabetes (HR 1.67, p < 0.001), and AA donor ethnicity (HR 1.56, p = 0.047) were significantly associated with graft failure., Conclusion: AAs undergoing deceased donor renal transplantation demonstrated lower graft survival compared to CAs. Conversely, this disparity did not exist among AAs undergoing living donor transplantation. AAs had higher rates of deceased donor transplantation, immunosuppression non-compliance, chronic rejection, and diabetes. Opportunities exist to use patient education, alternative immunosuppression regimens, and living transplantation to close the ethnic disparity in renal allograft survival., (Copyright © 2018 National Medical Association. Published by Elsevier Inc. All rights reserved.)
- Published
- 2019
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