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Kidney transplant graft survival is lower in Black recipients, especially young males, but this disparity narrows in older recipients and at high-performing transplant centers. Long-term survival also remains significantly lower for Black patients.
Area of Science:
- Nephrology
- Immunology
- Transplantation Medicine
Background:
- Racial disparities in kidney transplant outcomes are a significant concern in public health.
- Previous studies have indicated differences in graft survival rates between Black and Caucasian recipients, but the underlying factors require further investigation.
Purpose of the Study:
- To analyze racial differences in kidney transplant graft survival and function between Black and Caucasian recipients.
- To identify factors, including recipient age, donor type, and transplant center performance, that may influence these racial disparities.
Main Methods:
- Retrospective analysis of kidney transplant data from 1984 to 1989 and post-1986 cohorts.
- Comparison of one-year and long-term graft survival rates stratified by race, age, donor type, and transplant center success rates.
- Assessment of early graft function using serum creatinine levels.
Main Results:
- One-year graft survival was lower in Black recipients compared to Caucasians across various donor types, with the largest difference observed in young males (15-30 years).
- Racial differences in graft survival diminished in recipients over 45 years and in those transplanted after 1986 over 30 years.
- Black recipients exhibited poorer early graft function and significantly lower long-term graft survival (4-year half-life) compared to Caucasians (7.5-year half-life).
- Transplant center performance significantly impacted racial disparities; Black recipients at high-success centers showed comparable survival rates to Caucasians.
Conclusions:
- Kidney transplant outcomes remain significantly poorer for Black recipients, particularly younger individuals, with notable differences in both early function and long-term graft survival.
- Recipient age and transplant center success rates are critical factors that can mitigate racial disparities in kidney transplant outcomes.
- Further research and targeted interventions are needed to address the persistent racial gap in kidney transplantation and improve long-term graft survival for all patient populations.
Abstract:
1. One-year graft survival rates were 93% for recipients of HLA-identical sibling transplants in Blacks and Caucasians. One-year graft survival rates were lower in Blacks than Caucasians by 6% for parent donor, 8% for first cadaver, and 4% for cadaver donor retransplants between 1984 and 1989. 2. Although 1-year graft survival was consistently lower in Black recipients, there was no significant race difference when the recipient was over age 45 years. In transplants performed after 1986, there was no significant race difference when the recipient was over age 30 years. 3. Black recipients aged 15-30 years had the poorest 1-year graft survival at 64% each year between 1984 and 1988. One-year graft survival in comparable Caucasian recipients improved from 73-82% during this interval. The difference was greatest (18%) when comparing young Black and Caucasian males. 4. Caucasians had better early function than Blacks as judged from serum creatinine levels in the first 60 days. Fifty-two percent of Caucasians had excellent function (SCr less than 1.5 mg/dl) vs 37% of Blacks. Conversely, 22% of Blacks had SCr levels that never fell below 2.5 mg/dl vs 16% of Caucasians. There was no racial difference in early graft survival when transplants were stratified by function. The race effect became apparent after 6-12 months. 5. Long-term graft survival continues to differ dramatically between Black and Caucasian recipients. Transplant half-lives were consistently 4 years among Black and 7.5 years among Caucasian recipients of first cadaver transplants. Even comparing HLA-identical sibling transplants, the late loss rate in Blacks was double that in Caucasians. 6. The transplant center was an important factor in the race effect. Blacks transplanted at centers with overall high success rates had 79% 1-year graft survival, not significantly lower than that of Caucasian recipients. As the overall success rates declined at good and fair centers, the difference in 1-year graft survival between Black and Caucasian recipients increased from 8% to 12%. 7. The transplant center did not influence long-term graft survival in Black recipients. Transplant half-lives ranged from 4.9-3.9 years at excellent and fair centers, respectively. 8. The difference in graft survival between Caucasian and Black donors was primarily a center effect. In transplants to Caucasian recipients, there was no difference between Caucasian and Black donors at excellent and good centers, and a 16% difference at fair centers.