Simultaneous Pancreas-Kidney Transplantation in Caucasian versus African American Patients: Does Recipient Ethnicity Influence Outcomes?

J. Rogers¹, A. Farney¹, G. Orlando¹, C. Jay¹, V. Gurram¹, K. Gurung¹, A. Reeves-Daniel², A. Mena-Gutierrez², N. Sakhovskaya², M. Gautreaux¹, R. Stratta¹

¹Department of Surgery, Wake Forest Baptist Medical Center, Winston-Salem, NC, ²Department of Internal Medicine, Wake Forest Baptist Medical Center, Winston-Salem, NC

Meeting: 2020 American Transplant Congress

Abstract number: 400

Keywords: African-American, Kidney/pancreas transplantation, Outcome

Session Information

Session Name: Pancreas and Islet: All Topics I

Session Type: Oral Abstract Session

Date: Saturday, May 30, 2020

Session Time: 3:15pm-4:45pm

Presentation Time: 3:51pm-4:03pm

Location: Virtual

*Purpose: The influence of African American (AA) recipient ethnicity on outcomes following simultaneous pancreas-kidney transplantation (SPKT) in the modern era is uncertain.

*Methods: From 11/01 to 2/19, we retrospectively studied 158 Caucasian (C) and 57 AA patients (pts) undergoing SPKT at our center. All pts received depleting antibody induction (alemtuzumab – 155, rATG – 60) with tacrolimus/mycophenolate ± steroids maintenance immunosuppression. All pts underwent SPKT with intent-to-treat portal-enteric (PE) drainage (192 PE, 23 systemic-enteric drainage).

*Results: Mean follow-up was 97 months C vs 88 months AA; 80% of C and 70% of AA pts had at least 5 years f/u. Mean donor age (27 years C vs 23 AA), recipient age (44 years C vs 40 AA), and pancreas cold ischemia (15 hours) were similar between groups. Recipient gender (41% C female vs 44% AA female) was likewise similar. The AA group had fewer pts on peritoneal dialysis (30% C vs 10% AA), more pts with a longer duration (> 20 months) of dialysis (24% C vs 51% AA), more sensitized (PRA ≥ 20%) patients (6% C vs 19% AA), more 5-6 HLA mismatches (49% C vs 67% AA), more pts with pretransplant C-peptide levels ≥ 2.0 ng/ml (13% C vs 33% AA), and more pts with a shorter duration (< 20 years, 23% C vs 47% AA) and later age of onset (≥ 24 years old) of diabetes (13% C vs 30% AA, all p<0.05). The latter 3 differences suggest that a type 2 diabetes phenotype was more prevalent in the AA group. Overall patient survival (74% C vs 88% AA, p=0.04), kidney (63% C vs 67% AA), and pancreas (57% C vs 61% AA) graft survival rates (GSRs) slightly favored the AA group. Death-censored kidney (77% C vs 73% AA) and pancreas (69% C vs 66% AA) GSRs demonstrated that death with a functioning graft (DWFG) was more common in C (18%) vs AA pts (8%, p=0.05). Rates of early graft loss (usually thrombosis) were 7.6% C vs 3.5% AA whereas cumulative clinical acute rejection rates were 27% C vs 33% AA. The incidence of death-censored dual graft loss, usually due to acute and chronic rejection, was 11% C vs 23% AA (p=0.06).

*Conclusions: SPKT in AA recipients is characterized by longer pretransplant dialysis duration and less peritoneal dialysis, more sensitized patients and HLA-mismatching, more patients with a type 2 diabetes phenotype, and lower mortality. AA patients are at a greater risk for dual immunological graft loss whereas C patients are at greater risk for DWFG.

To cite this abstract in AMA style:

Rogers J, Farney A, Orlando G, Jay C, Gurram V, Gurung K, Reeves-Daniel A, Mena-Gutierrez A, Sakhovskaya N, Gautreaux M, Stratta R. Simultaneous Pancreas-Kidney Transplantation in Caucasian versus African American Patients: Does Recipient Ethnicity Influence Outcomes? [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/simultaneous-pancreas-kidney-transplantation-in-caucasian-versus-african-american-patients-does-recipient-ethnicity-influence-outcomes/. Accessed November 22, 2024.

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