Prospective data regarding kidney transplant outcomes in AA kidney transplant patients using modern immunosuppressive regimens are limited.
Methods: MORE was a 4-year, prospective, observational study at 40 US centers which enrolled adult de novo kidney transplant patients receiving mycophenolic acid (MPA) as enteric-coated mycophenolate sodium (EC-MPS) or mycophenolate mofetil (MMF) at hospital discharge.
Results: 904 tacrolimus-treated patients were analyzed: 218 AA patients (149 EC-MPS, 69 MMF) and 686 non-AA patients (467 EC-MPS, 219 MMF). Baseline characteristics for AAs vs non-AAs were similar other than living donors (24% vs 48%, p<0.01). Induction and tacrolimus exposure were similar in AAs vs non-AAs, but steroid therapy was significantly more frequent in AAs except at months 1 and 48. Within the AA group, more patients received the full recommended MPA dose (1.44g EC-MPS, 2.0g MMF) with EC-MPS vs MMF at month 6 (56% vs 36%, p=0.02) and month 36 (47% vs 17%, p=0.03). The observed 4-year rate of biopsy-proven acute rejection (BPAR) was 18.9% for AAs vs 10.7% for non-AAs (p<0.01). Four-year graft survival was lower for AAs vs non-AAs (89.1% vs 95.6%, p<0.01); patient survival was similar (96.5% vs 94.4%, p=0.99). After adjustment for donor type, lymphocyte-depleting induction, panel reactive antibodies <30% and delayed graft function, Cox regression analysis confirmed AA vs non-AA ethnicity was associated with a higher risk of BPAR (hazard ratio 1.91; 95% CI 1.21, 2.97; p=0.01) and graft loss (2.23; 1.13, 4.33; p=0.02). Efficacy outcomes were similar within both the AA and non-AA groups for EC-MPS vs MMF. Mean estimated GFR (eGFR, CKD-EPI formula) for AA vs non-AA patients was 57.4 vs 58.6mL/min/1.73m2 (p=0.50) at 1 year and 58.6 vs 57.8mL/min/1.73m2 (p=0.61) at 3 years (eGFR data at 4 years were available for only 34 AA patients and 83 non-AA patients due to lack of follow-up).
Conclusion: AA recipients of a kidney transplant are at a significantly increased risk of BPAR and graft loss under tacrolimus/MPA-based immunosuppression even after adjustment for confounding variables.
Pankewycz, O.: Grant/Research Support, Novartis. Shihab, F.: Grant/Research Support, Novartis, Speaker’s Bureau, Novartis, Other, Novartis, Consultant, Astellas, Consultant. Wiland, A.: Employee, Novartis Pharmaceuticals Corporation. McCague, K.: Employee, Novartis Pharmaceuticals Corporation. Chan, L.: Grant/Research Support, Novartis, Other, Novartis, Consultant.
To cite this abstract in AMA style:Narayanan M, Pankewycz O, Shihab F, Wiland A, McCague K, Chan L. Does African American (AA) Ethnicity Affect Kidney Transplant Outcomes at Four Years? An Analysis of the Mycophenolic Acid Observational Renal Transplant (MORE) Study [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/does-african-american-aa-ethnicity-affect-kidney-transplant-outcomes-at-four-years-an-analysis-of-the-mycophenolic-acid-observational-renal-transplant-more-study/. Accessed November 30, 2020.
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