Background: Racial differences in clinical and sociodemographic characteristics have been well recognized. This study aims to assess outcomes in African-American (AA) and white primary deceased donor kidney transplant recipients (KTRs) matched for key donor, recipient and transplant factors.

Methods: Among patients with primary deceased donor kidney transplants reported to UNOS/OPTN between 2001 and 2016, 5932 AAs were closely matched with 5932 white primary KTRs on age, gender, donor age, KDPI, cold ischemia time, BMI, cPRA, dialysis time, cause of kidney failure, year of transplant and number of HLA mismatches. Kaplan-Meier estimates of survival rates were compared with the log-rank test. The relative risks of death and graft loss in AA and white KTRs were assessed with multivariate Cox regression with adjustment for recipient and donor risk factors and graft failure considered as a time-dependent predictor of mortality.

Results: One-, five- and 10-year patient survival rates were 94.4%, 74.9%, and 43.7% for white and 95%, 79.9% and 48.8% for AA KTRs, respectively (p<0.001). The corresponding graft survival rates were 91.2%, 69.8%, and 40.2% for white and 90.4%, 68% and 39% for AA KTRs, respectively (p=0.05).

Multivariate Cox regression confirmed lower risk of death in AA recipients (relative risk 0.81 [0.73-0.92]). Graft failure was a strong predictor of death (RR=8.34, 7.29-9.77) as were, to a lesser extent, dialysis time (RR=1.09 , 1.06 – 1.11), and type 1 (RR=1.63, 1.30 – 1.65) and type 2 (RR=1.49 ,1.35 – 1.65) diabetes (compared to non-diabetics). African-American KTRs had fewer deaths due to malignancies (7.8% vs 10.5%) but all other causes of death showed a similar distribution.

The risk of graft loss was similar between AA and white KTRs in the adjusted analysis (RR=1.05 [0.99 – 1.12]). A higher proportion of AAs underwent transplant without induction (18.6% vs 14.7%) and were discharged on steroids (70.6% vs 65.9%); immunosuppression regimens were otherwise comparable . Acute and chronic rejection were more common among AAs as cause of graft failure (29.1% vs 17.8%) while death with functioning graft was more common among white KTRs (59.8% vs 41.9%).

Conclusion: African-American KTRs had significantly better patient survival and similar graft survival as compared to white KTRs when matched for key clinical variables.

CITATION INFORMATION: Tedla F., Brar A., John D., Sumrani N., Gruessner R., Gruessner A., Salifu M. Comparison of Outcomes in African-American and White Primary Kidney Transplant Recipients: A Matched-Pair Analysis Am J Transplant. 2017;17 (suppl 3).

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