title: Comparison of longer-term outcomes after kidney transplantation between Hispanic and non-Hispanic whites in the United States.
abstract: Little is known about the longer-term kidney transplant outcomes in the rapidly growing Hispanic population. Using the United States Renal Data System, we identified 105 250 Caucasian patients who received a first kidney transplant between January 1, 1996 and December 31, 2010. We tested for differences between Hispanic and non-Hispanic patients in the outcomes of (1) mortality, (2) all-cause graft failure, and (3) graft failure excluding death with a functioning graft. We used Cox regression to estimate (with 95% confidence intervals) multivariable-adjusted cause-specific hazard ratios (aHRCS ) for mortality and all-cause graft failure and subdistribution hazard ratios (aHRSD ) accounting for death as a competing risk for graft failure excluding death with a functioning graft. Both mortality [aHRCS  = 0.69 (0.65-0.73)] and all-cause graft failure [aHRCS  = 0.79 (0.75-0.83)] were lower in Hispanics. The association between Hispanic ethnicity and graft failure excluding death was modified by age (p < 0.003). Compared with non-Hispanic whites, graft failure excluding death with a functioning graft did not differ in Hispanics aged 18-39 years [aHRSD  = 0.96 (0.89-1.05)] or aged 40-59 years [aHRSD  = 1.08 (1.00-1.16)], but was 13% lower in those aged ≥60 years [aHRSD  = 0.87 (0.78-0.98)]. In conclusion, once accounting for differences in overall survival, better graft survival was found in older Hispanic patients, but among not those aged <60 years.
authors.affiliation: Department of Medicine, Division of Nephrology, Ohio State University School of Medicine, Columbus, OH; Department of Medicine, Division of Nephrology, Stanford University School of Medicine, Palo Alto, CA.
authors.forename: C M
authors.initials: CM
authors.lastname: Arce
authors.forename: C R
authors.initials: CR
authors.lastname: Lenihan
authors.forename: M E
authors.initials: ME
authors.lastname: Montez-Rath
authors.forename: W C
authors.initials: WC
authors.lastname: Winkelmayer
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000453:epidemiology* / Q000208:ethnology*; D006630:Hispanic or Latino; D006801:Humans; D015994:Incidence; D016030:Kidney Transplantation / Q000401:mortality; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D051437:Renal Insufficiency / Q000601:surgery; D012189:Retrospective Studies; D015996:Survival Rate; D014481:United States / Q000453:epidemiology; D044465:White People; D055815:Young Adult
keywords: disparities, epidemiology; health services and outcomes research; kidney transplantation/nephrology