Donor race and outcomes in kidney transplant recipients

Authors

  • Miklos Z. Molnar,

    1. Harold Simmons Center for Chronic Disease Research & Epidemiology, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, USA
    2. Institute of Pathophysiology, Semmelweis University, Budapest, Hungary
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  • Csaba P. Kovesdy,

    1. Division of Nephrology, Salem VA Medical Center, Salem, VA, USA
    2. Division of Nephrology, University of Virginia, Charlottesville, VA, USA
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  • Suphamai Bunnapradist,

    1. David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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  • Elani Streja,

    1. Harold Simmons Center for Chronic Disease Research & Epidemiology, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, USA
    2. Department of Epidemiology, UCLA School of Public Health, Los Angeles, CA, USA
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  • Mahesh Krishnan,

    1. David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
    2. DaVita, Inc, Denver, CO, USA
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  • Istvan Mucsi,

    1. Institute of Pathophysiology, Semmelweis University, Budapest, Hungary
    2. Institute of Behavioural Sciences, Semmelweis University, Budapest, Hungary
    3. Division of Nephrology, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada
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  • Keith C. Norris,

    1. David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
    2. Charles Drew University, Los Angeles, CA, USA
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  • Kamyar Kalantar-Zadeh

    Corresponding author
    1. David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
    2. Department of Epidemiology, UCLA School of Public Health, Los Angeles, CA, USA
    • Harold Simmons Center for Chronic Disease Research & Epidemiology, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, USA
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  • Conflict of interest: Dr. Krishnan is an employee of DaVita. Dr. Kalantar-Zadeh is the medical director of DaVita Harbor-UCLA/MFI in Long Beach, CA. The other authors have not declared any conflict of interest.

Corresponding author: Kamyar Kalantar-Zadeh, MD, MPH, PhD, Harold Simmons Center for Chronic Disease Research and Epidemiology, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, 1124 West Carson Street, C1-Annex, Torrance, CA 90509-2910, USA.

Tel.: 310 222 3891; fax: 310 782 1837;

e-mail: kamkal@ucla.edu

Abstract

Background

African Americans are at greater risk to reach end-stage renal disease and this risk may carry over in a kidney transplant recipient after kidney transplantation.

Methods

Linking the five-yr patient data of a large dialysis organization to the Scientific Registry of Transplant Recipients, we identified 13 692 hemodialysis patients who underwent first kidney transplantation. Mortality or graft failure and delayed graft function risks were estimated by Cox's regression (hazard ratio [HR] and 95% confidence interval) and logistic regression, respectively.

Results

Patients were 48 ± 14 yr old and included 39% women and 26% patients with diabetes. After adjusting for several relevant clinical and transplant-related variables, African American donor race was associated with higher all-cause mortality, with HR of 1.39 (1.09–1.78) for all-cause mortality, 1.80 (1.17–2.76) for cardiovascular mortality, 1.30 (1.03–1.64) for death-censored graft loss and 1.31 (1.10–1.57) for combined outcome over the six-yr observation period. In the non-African American recipient subcohort, but not in the African American recipient subcohort, African American donor race was associated with higher risk of death-censored graft loss (2.24 [1.44–3.49]) in our fully adjusted model.

Conclusions

African American donor race was associated with increased all-cause and cardiovascular mortality and graft loss.

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