title: Long-term outcome of highly sensitized African American patients transplanted with deceased donor kidneys.
abstract: Undertaking transplantation in highly sensitized African American (AA) patients as transplant recipients represents a unique challenge. We retrospectively compared the outcomes of AA with non-African American (NAA) patients who had panel reactive antibody >80% and received deceased donor (DD) kidneys by virtual crossmatch. Immunosuppressive regimen included basiliximab induction and tacrolimus, mycophenolate acid and steroids maintenance. Among 835 consecutive transplants from 1998 to 2007, 142 (17%) were sensitized patients including 89 (16.6%) AA and 53 (17.7%) NAA patients. The AA group had similar 5-year incidence of acute rejection as NAA group (21.4% vs. 26.4%, P = 0.25). Kaplan-Meier estimated graft survival at 1, 3 and 5 years were 91%, 85% and 82% in AA group, and 94%, 79% and 71% in NAA group (P = 0.08). The death-censored graft survival at 1, 3, and 5 years were 93%, 86% and 84% in AA group, and 96%, 83% and 78% in NAA group (P = 0.11). The 1, 3, and 5 years patient survivals were 93%, 88% and 85% in AA group, and 96%, 96% and 94% in NAA group (P = 0.17). Highly sensitized AA patients could be transplanted with DD kidneys at a similar rate as NAA patients, and they may not have a higher incidence of rejection or an inferior graft survival than NAA patients.
authors.affiliation: Section of Nephrology, Department of Medicine, School of Medicine, Tulane University, New Orleans, LA, USA.
authors.forename: Qing
authors.initials: Q
authors.lastname: Ren
authors.forename: Anil
authors.initials: A
authors.lastname: Paramesh
authors.forename: C Lillian
authors.initials: CL
authors.lastname: Yau
authors.forename: Mary
authors.initials: M
authors.lastname: Killackey
authors.forename: Douglas
authors.initials: D
authors.lastname: Slakey
authors.forename: Sandy
authors.initials: S
authors.lastname: Florman
authors.forename: Joseph
authors.initials: J
authors.lastname: Buell
authors.forename: Brent
authors.initials: B
authors.lastname: Alper
authors.forename: Eric
authors.initials: E
authors.lastname: Simon
authors.forename: L Lee
authors.initials: LL
authors.lastname: Hamm
authors.forename: Rubin
authors.initials: R
authors.lastname: Zhang
mesh_terms: D000328:Adult; D001741:Black or African American; D005260:Female; D006085:Graft Survival; D006680:HLA Antigens / Q000276:immunology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000276:immunology* / Q000401:mortality; D008145:Louisiana / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D014019:Tissue Donors; D016896:Treatment Outcome
chemical_list: D006680:HLA Antigens; D007166:Immunosuppressive Agents