Kidney transplants in African Americans and non-African Americans: equivalent outcomes with living but not deceased donors.
BACKGROUND
The outcome differences between ethnic groups after kidney transplantation have led to the characterization of African Americans (AA) as having high immune risk. Several multicenter clinical trials have reported better outcomes when AA receive higher doses of immunosuppression (I/S), suggesting pharmacokinetic (PK) and pharmacodynamic (PD) differences. However, the donor source has not been cited as an risk factor for outcome.


METHODS
Patient and graft survival rates of 469 AA were compared with 308 non-African Americans (nAA) who received kidney transplants between January 1, 1995 and December 31, 2002, and were followed-up through December 31, 2003. Gender, age, and I/S protocol were not different between the groups. Based on outcomes, open and laparoscopic donor groups were combined for analysis. Deceased donor kidneys comprised 49% of the AA kidneys but only 32% of the nAA kidneys (P < .000). Kaplan-Meier survival statistics were used for both patient and graft survival.


RESULTS
Patient survival rates for AA compared with nAA at 1, 3, 5, and 7 years were not statistically different for living (log rank statistic, 1 df, P = .56) versus deceased donor kidneys (log rank statistic, 1 df, P = .15). Kidney graft survival rates for AA compared with nAA at 1, 3, 5, and 7 years for living donor were similar (log rank statistic, 1 df, P = .493), but significantly different for deceased donor kidneys (log rank statistic, 1 df, P = .026).


CONCLUSIONS
The majority of living donation occurred between ethnically similar donor-recipient pairs, whereas deceased donors tended to be nAA. The difference demonstrated by donor source suggests that antigens may be more dissimilar or uniquely different between ethnic groups.
Light
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JA
Department of Transplantation Services, Washington Hospital Center, Washington, DC 20012, USA. jimmy.a.light@medstar.net
Barhyte
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Lahman
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D000328:Adult; D001741:Black or African American; D017677:Age Distribution; D000368:Aged; D002102:Cadaver; D004219:District of Columbia; D005260:Female; D006085:Graft Survival / Q000502:physiology*; D006801:Humans; D016030:Kidney Transplantation / Q000401:mortality / Q000502:physiology; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D044469:Racial Groups; D016019:Survival Analysis; D014019:Tissue Donors; D016896:Treatment Outcome