title: Kidney transplantation outcomes in African-, Hispanic- and Caucasian-Americans with lupus.
abstract: African-American recipients of kidney transplants with lupus have high allograft failure risk. We studied their risk adjusting for: (1) socio-demographic factors: donor age, gender and race-ethnicity; recipient age, gender, education and insurance; donor-recipient race-ethnicity match; (2) immunologic factors: donor type, panel reactive antibodies, HLA mismatch, ABO blood type compatibility, pre-transplant dialysis, cytomegalovirus risk and delayed graft function (DGF); (3) rejection and recurrent lupus nephritis (RLN). Two thousand four hundred and six African-, 1132 Hispanic-, and 2878 Caucasian-Americans were followed for 12 years after transplantation. African- versus Hispanic- and Caucasian-Americans received more kidneys from deceased donors (71.6%, 57.3% and 55.1%) with higher two HLA loci mismatches for HLA-A (50%, 39.6% and 32.4%), HLA-B (52%, 42.8% and 35.6%) and HLA-DR (30%, 24.5% and 21.1%). They developed more DGF (19.5%, 13.6% and 13.4%). More African- versus Hispanic- and Caucasian-Americans developed rejection (41.7%, 27.6% and 35.9%) and RLN (3.2, 1.8 and 1.8%). 852 African-, 265 Hispanic-, and 747 Caucasian-Americans had allograft failure (p < 0.0001). After adjusting for transplant era, socio-demographic-immunologic differences, rejection and RLN, the increased hazard ratio for allograft failure of African- compared with Caucasian-Americans became non-significant (1.26 [95% confidence interval 0.78-2.04]). African-Americans with lupus have high prevalence of risk factors for allograft failure that can explain poor outcomes.
authors: Division of Nephrology, University of Miami, Miller School of Medicine, 1120 NW 14th Street, Suite 360E, Miami, FL 33136, USA. gcontrer@med.miami.edu
authors: G
authors: G
authors: Contreras
authors: A
authors: A
authors: Mattiazzi
authors: D R
authors: DR
authors: Schultz
authors: G
authors: G
authors: Guerra
authors: M
authors: M
authors: Ladino
authors: L M
authors: LM
authors: Ortega
authors: M
authors: M
authors: Garcia-Estrada
authors: P
authors: P
authors: Ramadugu
authors: C
authors: C
authors: Gupta
authors: W L
authors: WL
authors: Kupin
authors: D
authors: D
authors: Roth
mesh_terms: D000328:Adult; D001741:Black or African American; D005006:Ethnicity; D005260:Female; D006084:Graft Rejection / Q000276:immunology*; D006085:Graft Survival / Q000276:immunology; D006630:Hispanic or Latino; D006801:Humans; D016030:Kidney Transplantation / Q000276:immunology*; D008875:Middle Aged; D012307:Risk Factors; D014184:Transplantation, Homologous / Q000276:immunology; D016896:Treatment Outcome; D044465:White People; D055815:Young Adult