Objective: The aim of this study was to assess disparities in post-operative mortality and graft failure among patients of African and European ancestry undergoing kidney transplantation.

Methods: This is a retrospective analysis of 1,400 patients who underwent kidney transplantation from 2003 to 2013 from a large, academic institution in Cleveland, OH. Relevant covariates including patient age, relevant demographic and relevant clinical covariates were obtained from an electronic transplant database. Continuous variables were compared using Wilcoxon rank-sum tests and categorical variables were assessed with [chi]² test to compare patients stratified by ethnicity. Survival analyses were conducted with Kaplan-Meier analyses and Cox multivariate regression model.

Results: The final cohort was comprised of 341 African American (AA) and 1059 European American (EA) patients. There were no significant differences in patient characteristics (age, gender, body mass index) [all p > 0.05]. Only 94/341 (27.6%) of AA patients underwent living donor transplant compared to 606/1059 (57.2%) of EA patients (p < 0.001). On Kaplan-Meier analysis, overall patient survival was not significantly different between the two groups (p = 0.15). Interestingly, AA patients who underwent deceased donor (DD) transplant had significantly poorer graft survival (p < 0.001), but equivocal graft survival if they had living donor transplants (p = 0.37). On sub-analysis, AA patients receiving DD transplants were more likely to be non-compliant with immunosuppression (p = 0.04) and more likely to have chronic rejection leading to graft failure (p = 0.002). AAs receiving DD transplants also had a higher rate of acute rejection compared to EA patients (27.5% vs. 17.9%, p = 0.003). Furthermore, AAs were less likely to receive another transplant following failure of their first DD graft (p = 0.04). Malignancy as a cause of death was more common among EA patients (p = 0.19).

Conclusions: Deceased donor graft survival among AA patients was lower. In our analysis, AAs were more likely to lose their kidney due to non-compliance with immunosuppresion and chronic rejection, with lower prospects of re-transplantation. Efforts should be made to address disparities in immunosuppression compliance, and to encourage more living donor transplant among AAs.

CITATION INFORMATION: Nyame Y, Gan V, Aram P, Greene D, Yerram N, Modlin C, Flechner S. Why Do African American Patients Display Disparities in Renal Graft Function Following Renal Transplantation? Am J Transplant. 2016;16 (suppl 3).

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