Renal graft survival in native and non-native European recipients

Most studies on the influence of recipient race on kidney transplant survival have been performed in the United States. Generally, they show a lower survival in African-Americans than in Caucasians. Since Rotterdam has gradually become a multi-ethnic society, we were able to study the effect of origin on kidney survival. We restricted our study to recipients of a primary cadaveric kidney graft between July 1983 and July 1997 who received cyclosporin as primary immunosuppression. Patients were divided into two main groups according to origin: European (n = 399) and non-European (n = 110). No statistical differences were found for mean donor age, sex distribution, or the total number of HLA-A and DR mismatches. Non-Europeans had significantly more mismatches on their HLA-B locus (P = 0.01) and recipient age was lower (P = 0.003). The reason non-Europeans had lost their native kidneys was more often hypertension and less often congenital or hereditary diseases compared to Europeans. The causes of death and of transplant failure did not differ. A multivariate Cox proportional hazards analysis did not show European or non-European origin to be an independent predictor of graft survival (two categories, P = 0.25). The variable origin in five categories did show an independent influence on graft survival, with Arab en African recipients running higher risks than European and Asian recipients. We conclude that, in our center, the prognosis after kidney transplantation is comparable for Europeans and non-Europeans; however, in the subcategories, Arab and African recipients have a worse prognosis.