Lung transplant outcomes in white and African American recipients: special focus on acute and chronic rejection.
BACKGROUND
The effects of lung transplant recipient race on post-transplant outcomes have not been adequately evaluated. This cohort study seeks to determine the characteristics of African American lung transplant recipients and the effects of African American race on post-transplant outcomes, particularly acute and chronic rejection, compared with white recipients, at a single center.


METHODS
There were 485 first-time lung transplantations (431 white, 47 African American, 5 Hispanic and 2 Asian recipients) performed at the University of Pennsylvania between 1991 and 2006. All white and African American recipients were compared based on pre-transplant diagnoses and post-transplant survival. The cohort from 1998 to 2006 (239 white and 25 African American recipients) was also compared based on acute rejection score (ARS) and development of bronchiolitis obliterans syndrome (BOS).


RESULTS
Chronic obstructive pulmonary disease was the most common diagnosis leading to lung transplantation in both groups, but sarcoidosis was a much more common indication in African American recipients (white, 1%; African American, 28%; p < 0.001). Survival was similar in the two groups (white vs African American groups: 1 month, 90.0% vs 87.2%; 1 year, 74.9% vs 74.5%; 5 years, 52.3% vs 50.5%, respectively; p = 0.84). Freedom from BOS at 3 years (white, 60.3%; African American, 62.8%; p = 0.30) and ARS per biopsy (white, 0.83 +/- 0.82; African American, 0.63 +/- 0.77; p = 0.31) were similar in both groups.


CONCLUSIONS
White and African American patients seek lung transplantation for different diseases, but post-transplant outcomes were found to be similar. Larger, multi-center studies are needed to confirm these results.
Lingaraju
Rajiv
R
Division of Pulmonary/Critical Care, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA.
Pochettino
Alberto
A
Blumenthal
Nancy P
NP
Mendez
James
J
Lee
James
J
Christie
Jason D
JD
Kotloff
Robert M
RM
Ahya
Vivek N
VN
Hadjiliadis
Denis
D
D000208:Acute Disease; D000328:Adult; D044383:Black People / Q000706:statistics & numerical data; D001989:Bronchiolitis Obliterans / Q000601:surgery; D002908:Chronic Disease; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology*; D006801:Humans; D006976:Hypertension, Pulmonary / Q000601:surgery; D016040:Lung Transplantation / Q000276:immunology / Q000401:mortality / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000601:surgery*; D017565:Sarcoidosis, Pulmonary / Q000601:surgery*; D016019:Survival Analysis; D016896:Treatment Outcome; D044465:White People / Q000706:statistics & numerical data; D001741:Black or African American