title: Outcome predictors in African-American deceased-donor renal allograft recipients.
abstract: The relative importance of donor and recipient risk factors in predicting outcomes in African-American (AA) renal allograft recipients receiving contemporary immunosuppression, including early steroid withdrawal, has not been previously examined. We assessed the impact of 21 risk factors on five primary outcomes in 132 deceased-donor AA renal allograft recipients transplanted from July 2001 to August 2006 with follow-up 6-67 (mean 35 +/- 17) months by univariate and multivariate analysis. Thymoglobulin or basiliximab was given for induction, and mycophenolate mofetil with either tacrolimus or sirolimus (SRL) +/- prednisone for maintenance. Non-compliance accounted for 26% of graft loss (GL) and 19% of acute rejection (AR) episodes, and was more prevalent in patients who were HCV+ and those on prednisone. Delayed graft function remained a significant predictor of GL, but not via increased AR, and donor ethnicity emerged as an important predictor of patient death. De novo use of SRL resulted in increased AR, and only increased recipient age significantly predicted new-onset diabetes mellitus. Our preliminary results suggest the need for improvements in patient education, pre-transplant psychosocial assessment, and late post-transplant psychosocial support and can be utilized to help guide donor/recipient selection and tailor immunosuppressive management to optimize outcomes in this challenging group of patients.
authors.affiliation: Section of Transplant Surgery, Department of Surgery, Wayne State University School of Medicine, Detroit, MI, USA.
authors.forename: Kristian L
authors.initials: KL
authors.lastname: Brown
authors.forename: Jose M
authors.initials: JM
authors.lastname: El-Amm
authors.forename: Mona D
authors.initials: MD
authors.lastname: Doshi
authors.forename: Atul
authors.initials: A
authors.lastname: Singh
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Cincotta
authors.forename: Katherina
authors.initials: K
authors.lastname: Morawski
authors.forename: Julian E
authors.initials: JE
authors.lastname: Losanoff
authors.forename: Miguel S
authors.initials: MS
authors.lastname: West
authors.forename: Scott A
authors.initials: SA
authors.lastname: Gruber
mesh_terms: D000328:Adult; D001741:Black or African American; D002102:Cadaver; D004334:Drug Administration Schedule; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage*; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D016030:Kidney Transplantation / Q000009:adverse effects / Q000208:ethnology*; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D011241:Prednisone / Q000008:administration & dosage*; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D014184:Transplantation, Homologous
chemical_list: D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D011241:Prednisone