Potential differences in kidney allograft outcomes between ethnicities when converting to sirolimus base immunosuppression.
OBJECTIVE
The aim of this study was to determine whether ethnicity impacts graft outcomes in kidney transplant patients converted to sirolimus (SRL) and maintained on either calcineurin inhibitors (CI) or mycophenolate mofetil (MMF) with steroids.


METHODS
This study analyzed kidney transplants converted to SRL and transplanted between July 1991 and April 2007. Patients were divided into 4 groups: group 1: African-Americans converted to SRL + CI; group 2: non-African-Americans converted to SRL + CI; group 3: African-Americans converted to SRL + MMF; group 4: non-African-Americans converted to SRL + MMF.


RESULTS
A total of 242 patients was included. Demographics, baseline immunosuppression, and reason for SRL conversion were similar among groups. Patients converted to SRL + CI regimens had significantly higher rates of acute rejection before SRL conversion, but equal rates after conversion. Development of proteinuria was similar across groups. African-American patients converted to SRL + MMF tended to have poorer outcomes compared with African-American patients converted to SRL + CI. Non-African-American patients converted to SRL + MMF tended to have better graft outcomes compared with non-African-American patients converted to SRL + CI.


CONCLUSIONS
African-Americans converted to SRL may benefit from continued CI, whereas non-African-Americans converted to SRL seem to have better outcomes with MMF. Further prospective studies are warranted to confirm these findings.
Patel
N
N
Department of Pharmacy, Medical University of South Carolina, Charleston, South Carolina, USA.
Taber
D J
DJ
Weimert
N A
NA
Fleming
J N
JN
Egidi
F M
FM
McGillicuddy
J
J
Bratton
C F
CF
Lin
A
A
Chavin
K D
KD
Baliga
P K
PK
D000293:Adolescent; D000328:Adult; D044383:Black People / Q000706:statistics & numerical data*; D004359:Drug Therapy, Combination / Q000706:statistics & numerical data; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology; D006085:Graft Survival / Q000502:physiology; D006207:Half-Life; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000276:immunology* / Q000706:statistics & numerical data*; D019520:Living Donors / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000031:analogs & derivatives / Q000627:therapeutic use; D044469:Racial Groups / Q000706:statistics & numerical data; D012189:Retrospective Studies; D020123:Sirolimus / Q000627:therapeutic use*; D014184:Transplantation, Homologous / Q000706:statistics & numerical data; D044465:White People / Q000706:statistics & numerical data*; D001741:Black or African American
D007166:Immunosuppressive Agents; D009173:Mycophenolic Acid; D020123:Sirolimus