title: Outcomes of African American kidney transplant recipients treated with sirolimus, tacrolimus, and corticosteroids.
abstract: BACKGROUND
  African American kidney transplant recipients generally exhibit poor long-term graft survival compared with other ethnic groups. The combination of sirolimus, tacrolimus, and corticosteroids has proven to be effective in reducing rejection episodes in high-risk organ and islet cell transplant recipients but has not yet been tested in a large number of African American patients.
  
  
  METHODS
  The outcomes of 56 African American adult, primary kidney transplant recipients treated with corticosteroids, sirolimus, and tacrolimus targeted to relatively low trough blood levels were compared with those of a concurrent group of 65 white patients treated with steroids, mycophenolate mofetil, and tacrolimus targeted to relatively high blood levels. Induction antibody therapy was not routinely used in either group.
  
  
  RESULTS
  The incidence of acute rejection in the first 3 posttransplantation months was 7.1% in African Americans and 16.9% in whites (P=NS). Actuarial 2-year patient, graft, and rejection-free graft survival rates were equivalent in the two groups. Posttransplantation diabetes mellitus occurred in 36% of the African American patients, despite similar doses of corticosteroids and lower trough levels of tacrolimus, compared with 15% of white patients (P=0.024).
  
  
  CONCLUSIONS
  The combination of corticosteroids, sirolimus, and relatively low doses of tacrolimus results in acute rejection, graft survival, and patient survival rates equivalent to those achieved in white patients receiving steroids, mycophenolate mofetil, and relatively high doses of tacrolimus, even without the routine use of induction antibody therapy. Posttransplantation diabetes mellitus remains a problem for African Americans receiving this combination of immunosuppressants, despite relatively low tacrolimus blood levels.
authors.affiliation: Departments of Medicine and Surgery, Case Western Reserve University and the Transplantation Service, University Hospitals of Cleveland, Cleveland, Ohio 44106, USA. deh5@po.cwru.edu.
authors.forename: Donald E
authors.initials: DE
authors.lastname: Hricik
authors.forename: Hany A S
authors.initials: HA
authors.lastname: Anton
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Knauss
authors.forename: Victoria
authors.initials: V
authors.lastname: Rodriguez
authors.forename: David
authors.initials: D
authors.lastname: Seaman
authors.forename: Christopher
authors.initials: C
authors.lastname: Siegel
authors.forename: John
authors.initials: J
authors.lastname: Valente
authors.forename: James A
authors.initials: JA
authors.lastname: Schulak
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage*; D000328:Adult; D000368:Aged; D003920:Diabetes Mellitus / Q000209:etiology; D004359:Drug Therapy, Combination; D005260:Female; D006084:Graft Rejection; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D016030:Kidney Transplantation / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D020123:Sirolimus / Q000008:administration & dosage*; D016559:Tacrolimus / Q000008:administration & dosage*; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones; D007166:Immunosuppressive Agents; D020123:Sirolimus; D016559:Tacrolimus