Introduction: Registry studies, largely from the United States, have consistently demonstrated inferior outcomes for black patients undergoing renal transplant. A recent Canadian publication has challenged this by reporting equivalent outcomes compared to white counterparts. The aim of this study was to determine outcomes for black patients in a large contemporary UK cohort.

Methods: Data was extracted from hospital informatics systems for all kidney allograft recipients transplanted at our centre between 2007 and 2015. Electronic records were then manually searched to facilitate data linkage between various sources to create a comprehensive database of baseline demographics, donor details, clinical/biochemical parameters, histology and clinical events.

Results: We collected data for 1,140 post transplant patients, with median follow up 4.4 years. Ethnicity breakdown of the cohort was White (72.1%), Black (5.5%), South Asian (17.6%) and other/unspecified (4.7%). Black ethnicity vs non-black ethnicity demonstrated equivalent patient survival (6.3% vs 7.1% respectively, p=0.531) but significantly worse death-censored graft survival (22.2% vs 9.5% respectively, p=0.003). Black patients had worse overall graft survival compared to non-black patients (25.4% vs 15.4% respectively, p=0.032). Black patients had borderline significance for increased risk of any rejection episode within the first year post transplantation compared to non-black patients (19.0% vs 11.2% respectively, p=0.053). There was no difference when comparing black vs non-black ethnicity to post-transplant events (cardiac events, cerebrovascular accidents or cancer) but black patients did have increased risk of post-transplant diabetes (16.7% vs 8.7% respectively, p=0.048) and peripheral vascular disease (6.3% vs 1.1% respectively, p=0.009). When adjusted for other variables in a Cox regression model, black ethnicity was not independently associated with graft failure.

Discussion: Our dataset shows that Black kidney allograft recipients have worse overall graft survival but black ethnicity itself is not a risk factor for graft loss. This is likely to be due to differing demographic or transplant specific factors, and unappreciated confounders, within this cohort. Further work, including analysis of national data from NHS Blood & Transplant, should be undertaken to provide clarity on kidney allograft outcomes for black patients in the UK.

CITATION INFORMATION: Tahir S, Jackson-Spence F, Gillott H, Everson F, Nath J, Sharif A. Black Ethnicity as a Risk Factor for Poor Kidney Allograft Outcomes Post-Transplantation. Am J Transplant. 2016;16 (suppl 3).

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