Influence of African-American ethnicity on acute rejection after early steroid withdrawal in primary kidney transplant recipients.
OBJECTIVE
The influence of African-American ethnicity on outcomes of kidney transplant recipients subjected to early steroid withdrawal remains controversial. Recent studies that suggest no higher risk among African Americans may be biased by recruitment of relatively small number of African Americans or by patient selection. We compared outcomes of African Americans to non-African Americans in a center in which early steroid withdrawal has become the standard of practice.


METHODS
This was a single-center prospective study of 133 consecutive patients receiving primary kidney transplants between January 2006 and December 2008, followed for >or=3 months, and managed with a similar immunosuppression regimen that included induction antibody therapy, tacrolimus, mycophenolate mofetil, and withdrawal of steroids on postoperative day 5. Acute rejection and other outcomes were compared in African-American patients (n = 55) and compared with those of non-African-American patients (n = 78).


RESULTS
During the first 12 months after early steroid withdrawal, African-American patients experienced a significantly higher cumulative incidence of acute rejection than non-African Americans (23.6% vs 7.7%; P = .020). Using multivariate logistic regression, ethnicity (odds ratio 3.33; P = .047) and HLA mismatch (odds ratio 1.44; P = .041) were significantly correlated with acute rejection independent of recipient age, gender, historical peak panel reactive antibody level (PRA) or PRA at time of transplant, time on dialysis, or donor source.


CONCLUSIONS
African Americans are at increased risk of acute rejection after early steroid withdrawal, particularly when they receive kidneys from poorly matched donors.
Padiyar
A
A
Department of Medicine, University Hospitals Case Medical Center, Cleveland, Ohio 44106, USA. apadiyar@gmail.com
Augustine
J J
JJ
Bodziak
K A
KA
Aeder
M
M
Schulak
J A
JA
Hricik
D F
DF
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data*; D000368:Aged; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005006:Ethnicity / Q000706:statistics & numerical data*; D006084:Graft Rejection / Q000453:epidemiology*; D006680:HLA Antigens / Q000276:immunology; D006650:Histocompatibility Testing; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000276:immunology / Q000502:physiology*; D019520:Living Donors / Q000706:statistics & numerical data; D008775:Methylprednisolone / Q000008:administration & dosage / Q000627:therapeutic use; D008875:Middle Aged; D011241:Prednisone / Q000008:administration & dosage / Q000627:therapeutic use; D013375:Substance Withdrawal Syndrome / Q000453:epidemiology
D000305:Adrenal Cortex Hormones; D006680:HLA Antigens; D007166:Immunosuppressive Agents; D011241:Prednisone; D008775:Methylprednisolone