Introduction: American Indian (AI) patients experience significant disparity in access to kidney transplant (KTx) with reported similar graft outcomes after KTx. Our objective is to assess graft survival and analyze cardiovascular (CV), infectious, and malignancy outcomes in this cohort. Methods: We analyzed 165 AI and 165 non-Hispanic white patients matched for the year of transplant between 2007-2015 at a single transplant center. Results: AI patients were younger (mean 51.2±12.2 vs 59.4±12.8 years), required dialysis pre-KTx (94.5% vs 61.2%), and had more diabetes (65.5% vs 21.8%) compared to the white cohort (all p<0.0001). AI patients were more likely to receive deceased donor KTx (82.4% vs 44.8% p< 0.0001) and have delayed graft function (43.0% vs 15.8%, p<0.0001). Risk of acute rejection (AR) was increased for AI patients compared to whites (HR 1.55 95%CI 1.00-2.39, p=0.046). Graft failure cumulative incidence was similar between the two groups, however AI patients had increased risk of the combined outcome of graft failure or death (HR 1.89 (95%CI 1.06-3.37), p=0.0298). Rates of CV outcomes were similar (AI 15.2% vs 18.2% p=0.4602). However AI patients were more likely to suffer infectious complications (HR 1.81 95%CI 1.30-2.52, p=0.0005). The incidence of BK and CMV were similar. AI patients had lower rates of malignancy pre (4.8% vs 27.9%, p<0.0001) and post-KTx (3.0% vs 13.3%, p<0.0001) compared to whites. Discussion: AI patients experience increased incidence of AR and increased risk of death and/or graft failure. We show for the first time increased risk for infectious complications but improved risk for malignancy and similar CV risk for AI patients compared to whites post-KTx. Future efforts to determine variables predictive of graft failure, mortality and infectious risk are warranted.

CITATION INFORMATION: Seipp R., Zhang N., Khamash H., Leischow S., Sharma A., Heilman R., Keddis M. Graft and Patient Outcomes after Kidney Transplant for American Indians Am J Transplant. 2017;17 (suppl 3).

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