title: Significant racial differences in the key factors associated with early graft loss in kidney transplant recipients.
abstract: BACKGROUND
  There is continued and significant debate regarding the salient etiologies associated with graft loss and racial disparities in kidney transplant recipients.
  
  
  METHODS
  This was a longitudinal cohort study of all adult kidney transplant recipients, comparing patients with early graft loss (<5 years) to those with graft longevity (surviving graft with at least 5 years of follow-up) across racial cohorts [African-American (AA) and non-AA] to discern risk factors.
  
  
  RESULTS
  524 patients were included, 55% AA, 151 with early graft loss (29%) and 373 with graft longevity (71%). Consistent within both races, early graft loss was significantly associated with disability income [adjusted odds ratio (AOR) 2.2, 95% CI 1.1-4.5], Kidney Donor Risk Index (AOR 3.2, 1.4-7.5), rehospitalization (AOR 2.1, 1.0-4.4) and acute rejection (AOR 4.4, 1.7-11.6). Unique risk factors in AAs included Medicare-only insurance (AOR 8.0, 2.3-28) and BK infection (AOR 5.6, 1.3-25). Unique protective factors in AAs included cardiovascular risk factor control: AAs with a mean systolic blood pressure <150 mm Hg had 80% lower risk of early graft loss (AOR 0.2, 0.1-0.7), while low-density lipoprotein <100 mg/dl (AOR 0.4, 0.2-0.8), triglycerides <150 mg/dl (AOR 0.4, 0.2-1.0) and hemoglobin A1C <7% (AOR 0.2, 0.1-0.6) were also protective against early graft loss in AA, but not in non-AA recipients.
  
  
  CONCLUSIONS
  AA recipients have a number of unique risk factors for early graft loss, suggesting that controlling cardiovascular comorbidities may be an important mechanism to reduce racial disparities in kidney transplantation.
authors: Division of Transplant Surgery, Medical University of South Carolina, Charleston, S.C., USA.
authors: David J
authors: DJ
authors: Taber
authors: Kevin
authors: K
authors: Douglass
authors: Titte
authors: T
authors: Srinivas
authors: John W
authors: JW
authors: McGillicuddy
authors: Charles F
authors: CF
authors: Bratton
authors: Kenneth D
authors: KD
authors: Chavin
authors: Prabhakar K
authors: PK
authors: Baliga
authors: Leonard E
authors: LE
authors: Egede
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data*; D000368:Aged; D001739:BK Virus; D002318:Cardiovascular Diseases / Q000453:epidemiology; D015331:Cohort Studies; D050171:Dyslipidemias / Q000453:epidemiology; D005260:Female; D006084:Graft Rejection / Q000208:ethnology* / Q000517:prevention & control; D006085:Graft Survival; D054624:Health Status Disparities; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007676:Kidney Failure, Chronic / Q000601:surgery*; D016030:Kidney Transplantation; D008137:Longitudinal Studies; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000031:analogs & derivatives / Q000627:therapeutic use; D016017:Odds Ratio; D027601:Polyomavirus Infections / Q000453:epidemiology; D011241:Prednisone / Q000627:therapeutic use; D012189:Retrospective Studies; D012307:Risk Factors; D016559:Tacrolimus / Q000627:therapeutic use; D013997:Time Factors; D014481:United States
chemical_list: D007166:Immunosuppressive Agents; D009173:Mycophenolic Acid; D011241:Prednisone; D016559:Tacrolimus