Transplant outcomes in female African American recipients
Patel A, Prashar R, and Lim D. Transplant outcomes in female African American recipients. Am J Transplant 2018;18(Suppl 4):585.
Am J Transplant
We are aware of the multifactorial healthcare disparity affecting African American (AA) population with regards to renal transplantation. Little is known about AA female renal transplant recipients (RTR). We undertook a study to analyze listing, wait-time and post-transplant outcomes in this population. Methods: Retrospective data of RTR from United Network of Organ Sharing registry (2006-2016) were analyzed. R were grouped into African American (AA) female (F) and male (M) as well as non-AAF and non-AAM. Death censored graft failure(DCGF) and patient death was estimated between AAM and AAF RTR as well as AAF and non-AAF RTR by hazard ratios (HR)with various transplant variables, significance for this study was set at p value<0.05. Result: Lower number of AAF were on the waitlist and had lower preemptive listing compared to non-AAF and AAM. AAF demonstrated longer wait time and better survival on waitlist compared to AAM. Post transplantation, compared to non-AAF, AAF had significantly lower HR for death (0.82) but higher for DCGF (1.15). AAF demonstrated GF from chronic rejection (HR 1.58) and from acute rejection (HR 1.30). Among AA, regardless of other transplant variables, AAF had lower HR for death (0.85); with higher KDPI (HR 1.61) and diabetes as cause of ESRD (HR 1.35) being confounding factors for death. AAM demonstrated an increase in risk of death (HR 1.15) compared to AAF, with black donor status (HR 1.16), longer OPO wait time in months (HR 1.004) and higher cPRA (HR 1.003) as additional risk factors for death. Recipient BMI (HR 0.98) and any induction (HR 0.83) were associated with survival in AAM but not in AAF. OPO wait time, donor age or gender or level of HLA mismatch did not appear to be predictive for death in AAF. There was no difference in DCGF between the AAM and AAF. Significant risk factors for DCGL were duration of dialysis (HR 1.33) and recipient comorbidity score (HR 1.13) in AAM, while longer cold ischemia time was risk factor in AAF. HLA mismatch, cPRA, diagnosis of glomerulonephritis were not significantly associated with DCGL in AAF. In conclusion, AAF appeared to have significantly higher patient survival compared to AAM as well as non-AAF. Their survival was also higher on the waitlist. However, DCGL was comparable to AAM; higher than non-AAF. The higher GL in AAF appeared to be strongly related to acute and chronic rejection; prudent monitoring of compliance and immunosuppression could prolonged graft survival.