Simultaneous Pancreas-Kidney Transplantation in Caucasian versus African American Patients: Does Recipient Ethnicity Influence Outcomes?
1Wake Forest Baptist Medical Center, Winston-Salem, NC, 2Department of Surgery, Wake Forest Baptist Medical Center, Winston-Salem, NC, 3Internal Medicine, Wake Forest Baptist Medical Center, Winston-Salem, NC, 4Department of Pharmacy, Wake Forest Baptist Medical Center, Winston-Salem, NC
Meeting: 2021 American Transplant Congress
Abstract number: 412
Keywords: African-American, Outcome, Pancreas transplantation
Topic: Clinical Science » Pancreas » Pancreas and Islet: All Topics
Session Information
Session Time: 7:30pm-8:30pm
Presentation Time: 8:10pm-8:20pm
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, Gurung K, Sharda B, Reeves-Daniel A, Mena-Gutierrez A, Sakhovskaya N, Doares W, Kaczmorski S, Magid M, Gautreaux M, Stratta R. Simultaneous Pancreas-Kidney Transplantation in Caucasian versus African American Patients: Does Recipient Ethnicity Influence Outcomes? [abstract]. Am J Transplant. 2021; 21 (suppl 3). https://atcmeetingabstracts.com/abstract/simultaneous-pancreas-kidney-transplantation-in-caucasian-versus-african-american-patients-does-recipient-ethnicity-influence-outcomes-2/. Accessed May 9, 2025.« Back to 2021 American Transplant Congress