title: Twenty years of evolving trends in racial disparities for adult kidney transplant recipients.
abstract: Disparities in outcomes for African American (AA) kidney transplant recipients have persisted for 40 years without a comprehensive analysis of evolving trends in the risks associated with this disparity. Here we analyzed U.S. transplant registry data, which included adult Caucasian or AA solitary kidney recipients undergoing transplantation between 1990 and 2009 comprising 202,085 transplantations. During this 20-year period, the estimated rate of 5-year graft loss decreased from 27.6% to 12.8%. Notable trends in baseline characteristics that significantly differed by race over time included the following: increased prevalence of diabetes from 2001 to 2009 in AAs (5-year slope difference: 3.4%), longer time on the waiting list (76.5 more days per 5 years in AAs), fewer living donors in AAs from 2003 to 2009 (5-year slope difference: -3.36%), more circulatory death donors in AAs from 2000-09 (5-year slope difference: 1.78%), and a slower decline in delayed graft function in AAs (5-year slope difference: 0.85%). The absolute risk difference between AAs and Caucasians for 5-year graft loss significantly declined over time (-0.92% decrease per 5 years), whereas the relative risk difference actually significantly increased (3.4% increase per 5 years). These results provide a mixed picture of both promising and concerning trends in disparities for AA kidney transplant recipients. Thus, although the disparity for graft loss has significantly improved, equity is still far off, and other disparities, including living donation rates and delayed graft function rates, have widened during this time.
authors.affiliation: Division of Transplant Surgery, College of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA; Department of Pharmacy Services, Ralph H. Johnson VAMC, Charleston, South Carolina, USA. Electronic address: taberd@musc.edu.
authors.forename: David J
authors.initials: DJ
authors.lastname: Taber
authors.affiliation: Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA.
authors.forename: Mulugeta
authors.initials: M
authors.lastname: Gebregziabher
authors.affiliation: Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA.
authors.forename: Kelly J
authors.initials: KJ
authors.lastname: Hunt
authors.affiliation: Division of Transplant Nephrology, College of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA.
authors.forename: Titte
authors.initials: T
authors.lastname: Srinivas
authors.affiliation: Division of Transplant Surgery, College of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA.
authors.forename: Kenneth D
authors.initials: KD
authors.lastname: Chavin
authors.affiliation: Division of Transplant Surgery, College of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA.
authors.forename: Prabhakar K
authors.initials: PK
authors.lastname: Baliga
authors.affiliation: Veteran Affairs HSR&D Health Equity and Rural Outreach Innovation Center (HEROIC), Ralph H. Johnson VAMC, Charleston, South Carolina, USA.
authors.forename: Leonard E
authors.initials: LE
authors.lastname: Egede
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data*; D051799:Delayed Graft Function / Q000453:epidemiology / Q000208:ethnology; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology / Q000208:ethnology; D006085:Graft Survival; D054625:Healthcare Disparities / Q000706:statistics & numerical data / Q000639:trends*; D006801:Humans; D016030:Kidney Transplantation / Q000706:statistics & numerical data / Q000639:trends*; D019520:Living Donors / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D012042:Registries; D012189:Retrospective Studies; D013997:Time Factors; D066027:Transplant Recipients / Q000706:statistics & numerical data*; D014481:United States; D014850:Waiting Lists; D044465:White People / Q000706:statistics & numerical data*
keywords: African American; graft loss; kidney transplant; racial disparities