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Why Do African American Patients Display Disparities in Renal Graft Function Following Renal Transplantation?

Y. Nyame, V. Gan, P. Aram, D. Greene, N. Yerram, C. Modlin, S. Flechner.

Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH.

Meeting: 2016 American Transplant Congress

Abstract number: A281

Keywords: African-American, Graft survival, Outcome

Session Information

Date: Saturday, June 11, 2016

Session Name: Poster Session A: Poster Session III: Kidney Complications-Other

Session Time: 5:30pm-7:30pm

 Presentation Time: 5:30pm-7:30pm

Location: Halls C&D

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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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To cite this abstract in AMA style:

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? [abstract]. Am J Transplant. 2016; 16 (suppl 3). https://atcmeetingabstracts.com/abstract/why-do-african-american-patients-display-disparities-in-renal-graft-function-following-renal-transplantation/. Accessed March 8, 2021.

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