The effect of race and ethnicity on kidney allograft outcome

Asian recipients of cadaveric renal allografts had the best long-term survival rates. Five-year graft survival rates were 66% for 1,713 Asians, 61% for 4,722 Hispanics and 33,190 Whites, and 47% for 12,948 Blacks. This trend had already been established at one-year posttransplant. Transplant half-lives calculated after 6 months were 12 years for Asians, 10 years for Whites, 9 years for Hispanics and 5 years for Blacks. These have all improved over the last 4 years. Part of the explanation for the outstanding half-life for Asian recipients is the 15 year half-life of the 672 Asian females reported. The superior graft survival for Asian recipients may be due in part to the low incidence of sensitization, the low incidence of acute rejection and chronic rejection leading to graft loss, and the high prevalence of primary disease entities that have been associated with excellent long-term prognoses, especially IgA nephropathy and chronic glomerulonephritis. Hispanic recipients also had excellent short- and long-term graft survival rates. This may be due to having the lowest incidence of early acute rejection episodes compared with all other racial groups, and the limited deleterious effect of ATN on long-term graft survival among Hispanics. The poor overall graft survival for Black recipients may be due to poor HLA matching, a high rate of sensitization and a grim effect of sensitization on graft survival, the high incidences of acute rejection and ATN, and the high incidence of HTN both pre- and posttransplant. The only subgroups of Black recipients who had graft survival rates that were comparable to other racial groups were the zero-HLA-mismatched Black recipients and those Black recipients over age 65. Long-term patient survival rates were the best for Asians and Hispanics (89% and 90% at 5 years, respectively). The 5-year patient survival rates were lower for Blacks and Whites (86% each). There was no difference in patient survival at one-year posttransplant (95-96% for each group). A higher proportion of White diabetic recipients received simultaneous SPK transplants (31%) than Black (10%), Hispanic (11%) or Asian (7%) diabetics. The reasons for this disparity are unclear. However, SPK transplants improved 5-year kidney graft survival for Whites (67% vs 55% in patients receiving kidneys alone), but were not associated with improved 5-year kidney survival among non-Whites. White donors accounted for the majority of all transplanted organs (79%). Matching donor and recipient race ("race matching") led to better long-term allograft survival for White recipients only. There was no donor-recipient "race matching" effect for minority groups.