Donor Black Race Modifies the Association Between Increasing Donor Age and Graft Failure Following Living Kidney Transplantation

K. Atiemo, R. Baudier, A. Anderson

Tulane University, New Orleans, LA

Meeting: 2022 American Transplant Congress

Abstract number: 1759

Keywords: African-American, Donation, Kidney, Outcome

Topic: Clinical Science » Kidney » 50 - Health Equity and Access

Session Information

Session Name: Health Equity and Access

Session Type: Poster Abstract

Date: Tuesday, June 7, 2022

Session Time: 7:00pm-8:00pm

Presentation Time: 7:00pm-8:00pm

Location: Hynes Halls C & D

*Purpose: Transplantation utilizing Black living donor kidneys is associated with poorer outcomes.A possible explanation is genetic(APOL1). Kidneys from healthy older Black donors are considered lower risk because genetic phenotypes which portend poorer outcomes are often apparent at younger ages. Thus, older healthy Black living donors should have the same post-transplant outcomes as similar age kidneys from White donors. Herein, we examine this hypothesis.

*Methods: Using the United Network for Organ Sharing data, we identified first living donor kidney transplants between1/2000, and 12/2019. Recipients were categorized by donor race (NHW/Black) and donor age (&lt34(young), 35-50(mid), &gt50(old)). Analyses employed Cox multivariate regression including interaction terms for donor race and donor age and adjusting for donor cigarette use, donor BMI, recipient-age, race, cause of renal failure, dialysis, insurance, cpra ;hla B/DR mismatch, donor/recipient both male, donor/recipient related and era.

*Results: 63,309 adult recipients/corresponding donors met inclusion criteria. Among young donors 12,670(76%) were White 3,920 (24%) were Black. Among mid donors 22,577(85%) were White and 3,970 (15%) were Black. Among old donors 18,694 (92%) were White, 1,478 (8%) were Black. In each donor age category, Black donors had greater unadjusted graft failure. Table 1.Multivariable model showed increasing donor age [young vs mid HR 1.1(95% CI 1.04-1.2)] /[young vs old HR 1.4 (95% CI 1.3-1.5)] and donor race [HR 1.4 (95% CI 1.3-1.6)] were associated with graft failure. With an interaction term for donor race and donor age included in the model, Black donors had increased risk of graft failure relative to Whites irrespective of donor age[p value interaction 0.008]. Table 2

*Conclusions: Healthy older Black kidney donors continue to demonstrate poorer post-transplant outcomes compared to similar age kidneys from White donors. Further investigation should focus on underlying social/environmental factors that could be contributing to poorer outcomes. If living kidney donation is to be encouraged among Blacks, such disparities should be urgently addressed.

Table 1: Death censored graft failure (%Grafts functioning)
	Young	Young	Mid	Mid	Old	Old
	White	Black	White	Black	White	Black
1 year	98.5	97.3	98.2	97.3	97.4	97.6
3 year	96.0	91.7	95.9	92.0	95.5	92.8
5 year	93.4	84.4	92.9	85.5	91.8	85.7
Total Failures	1390	898	2528	853	2201	280

Table 2: Hazard Ratio of Death Censored Graft failure[Interaction Model] (ref=White)
Young	HR 1.5 (95% CI 1.3-1.7)
Mid	HR 1.4 (95% CI 1.3-1.6)
Old	HR 1.2 (95% CI 1.05-1.4)

To cite this abstract in AMA style:

Atiemo K, Baudier R, Anderson A. Donor Black Race Modifies the Association Between Increasing Donor Age and Graft Failure Following Living Kidney Transplantation [abstract]. Am J Transplant. 2022; 22 (suppl 3). https://atcmeetingabstracts.com/abstract/donor-black-race-modifies-the-association-between-increasing-donor-age-and-graft-failure-following-living-kidney-transplantation/. Accessed May 8, 2025.

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