title: Effect of mycophenolate mofetil on long-term outcomes in African american renal transplant recipients.
abstract: African American renal transplant recipients have poorer graft survival. A study using the United States Renal Data Registry documented an improvement in graft survival for patients who took mycophenolate mofetil (MMF) compared with azathioprine (AZA). This analysis did not address the impact of MMF on African American renal transplant recipients. The present study aimed to quantify potential beneficial effects of MMF therapy on long-term renal allograft survival in African Americans. With the use of the United States Renal Data Registry, all adult Caucasian and African American patients who had received a primary renal transplant between 1988 and 1997 were analyzed by Kaplan-Meier analysis and Cox proportional hazard models. Primary study end points were death with a functioning graft and graft failure censored for death. A total of 57,926 patients were studied. For African Americans, 3-yr patient survival was 96.3 versus 93.2% (P<0.001) for MMF and AZA, respectively. Three-yr death-censored graft survival for African Americans was 85.8 versus 75.1% (P<0.001) for MMF and AZA, respectively. For Caucasians, 3-yr patient survival was 97.3 versus 93.2% for MMF and AZA, respectively. Three-yr death-censored graft survival for Caucasians was 90.1 versus 86.4% (P<0.001) for MMF and AZA, respectively. By multivariate analysis, MMF was associated with a significant reduction in the relative risk for all study end points in African Americans. MMF therapy is associated with both improved patient and death-censored graft survival in African American renal transplant recipients. This benefit is comparable to the benefit of MMF in Caucasian renal transplant recipients.
authors.affiliation: Departments of Medicine and Surgery, University of Michigan, Ann Arbor, Michigan.
authors.forename: Herwig-Ulf
authors.initials: HU
authors.lastname: Meier-Kriesche
authors.affiliation: Departments of Medicine and Surgery, University of Michigan, Ann Arbor, Michigan.
authors.forename: Akinlolu O
authors.initials: AO
authors.lastname: Ojo
authors.affiliation: Departments of Medicine and Surgery, University of Michigan, Ann Arbor, Michigan.
authors.forename: Alan B
authors.initials: AB
authors.lastname: Leichtman
authors.affiliation: Departments of Medicine and Surgery, University of Michigan, Ann Arbor, Michigan.
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Punch
authors.affiliation: Departments of Medicine and Surgery, University of Michigan, Ann Arbor, Michigan.
authors.forename: Julie A
authors.initials: JA
authors.lastname: Hanson
authors.affiliation: Departments of Medicine and Surgery, University of Michigan, Ann Arbor, Michigan.
authors.forename: Diane M
authors.initials: DM
authors.lastname: Cibrik
authors.affiliation: Departments of Medicine and Surgery, University of Michigan, Ann Arbor, Michigan.
authors.forename: Bruce
authors.initials: B
authors.lastname: Kaplan
mesh_terms: D000328:Adult; D001741:Black or African American; D001379:Azathioprine / Q000627:therapeutic use; D044383:Black People; D005260:Female; D006084:Graft Rejection / Q000209:etiology; D006085:Graft Survival; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007676:Kidney Failure, Chronic / Q000188:drug therapy* / Q000208:ethnology / Q000601:surgery*; D016030:Kidney Transplantation / Q000401:mortality; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000031:analogs & derivatives* / Q000627:therapeutic use*; D016016:Proportional Hazards Models; D012307:Risk Factors; D016896:Treatment Outcome; D044465:White People
chemical_list: D007166:Immunosuppressive Agents; D009173:Mycophenolic Acid; D001379:Azathioprine