title: Cardiovascular risk factors contribute to disparities in graft outcomes in African American renal transplant recipients: a retrospective analysis.
abstract: Data examining cardiovascular (CV) risk factors in renal transplant recipients (RTRs) and their contribution to the disparity in graft survival between African American (AA) patients and non-AAs is limited. A single-center, retrospective analysis of 1003 adult RTRs from January 1, 2000 to May 1, 2008 to inspect the impact of race on post-transplant CV events, treatment of CV risk factors and their independent influence on graft outcomes was performed. AAs experienced a higher incidence of late graft loss, with 1- and 5-year graft survival rates of 93% and 76% vs 95% and 84% in the non-AA group, respectively. AA patients had a higher prevalence of hypertension (HTN) and diabetes mellitus (DM) and demonstrated reduced control of DM post-transplant (AA 74% vs non-AA 82%, p = 0.053). Multivariate analysis for graft survival indicated acute rejection, delayed graft function (DGF) and incidence of CV events were significant risk factors for graft failure, while the use of beta-blockers, angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs) and 3-hydroxy-3-methyl-glutaryl-coenzyme A (HMG-CoA) reductase inhibitors were protective. In conclusion, after controlling for CV risk factors and events, race did not have an independent effect on outcomes, suggesting CV risk factors and events contribute to this disparity. Clinical summary. AAs experienced a higher rate of graft failure and CV events; after adjusting for multiple immunological and CV risk factors, race no longer remained an independent risk factor for post-transplant CV events or graft failure; although disparities in post-transplant outcomes remain, race alone does not account for the disparity; the racial disparity is due to the higher incidence of DGF and acute rejection, as well as traditional CV risk factors, including HTN and DM.
authors.affiliation: Division of Transplant Surgery, Department of Surgery.
authors.forename: Arun P
authors.initials: AP
authors.lastname: Palanisamy
authors.forename: Clarence E
authors.initials: CE
authors.lastname: Schiltz
authors.forename: Nicole A
authors.initials: NA
authors.lastname: Pilch
authors.forename: Kelly J
authors.initials: KJ
authors.lastname: Hunt
authors.forename: Satish N
authors.initials: SN
authors.lastname: Nadig
authors.forename: Jacob E
authors.initials: JE
authors.lastname: Dowden
authors.forename: John W
authors.initials: JW
authors.lastname: McGillicuddy
authors.forename: Prabhakar K
authors.initials: PK
authors.lastname: Baliga
authors.forename: Kenneth D
authors.initials: KD
authors.lastname: Chavin
authors.forename: David J
authors.initials: DJ
authors.lastname: Taber
mesh_terms: D000328:Adult; D001741:Black or African American; D057911:Angiotensin Receptor Antagonists / Q000008:administration & dosage; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000008:administration & dosage; D048909:Diabetes Complications / Q000188:drug therapy; D005260:Female; D006084:Graft Rejection / Q000196:embryology* / Q000209:etiology* / Q000517:prevention & control; D006085:Graft Survival / Q000187:drug effects*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage; D006973:Hypertension / Q000150:complications / Q000188:drug therapy; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors
chemical_list: D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors
keywords: Cardiovascular risk; diabetes mellitus; hypertension; racial disparities; renal transplant