Does Ethnicity Impact Elderly Kidney Transplant Recipient Outcomes?
Bajjoka I, Yaldo A, Serxa S, Foley S, Crombez C, and Abouljoud M. Does Ethnicity Impact Elderly Kidney Transplant Recipient Outcomes? Am J Transplant 2019; 19:1101-1102.
Am J Transplant
Purpose: Elderly patients represent a growing proportion of the kidney transplant population. In order to address the needs of this special group, risk factors for adverse transplant outcomes need to be evaluated.
Methods: A single-center retrospective analysis of kidney transplant patients from 2004 to 2018 was conducted by medical record review. Elderly patients were defined as those 65 years of age or greater at the time of transplant. A total of 275 patients met this criteria. Subjects were divided into two groups, Caucasians (C) and African Americans (AA). Patients who identified as another ethnic group were excluded from this analysis due to a small sample size (n=18). The remaining subjects' baseline characteristics, demographics, graft function, graft survival, and patient survival were analyzed and compared. Graft function was evaluated using first biopsy-proven acute rejection (BPAR) and estimated glomerular filtration rates (eGFR) post-transplant. BPAR were graded using Banff schema (>2A = severe).
Results: Groups were followed for a similar number of days post-transplant [C: 1634 (792, 2163); AA: 1755(829. 5, 2284. 5); p>0. 05]. Recipients had similar median ages of 69 (66, 72) years old. AA received more deceased donors [C: 87 (59. 2); AA: 89 (81. 6); pO. 001] and more expanded criteria donors [C: 87 (59. 2); AA: 89 (81. 6); pO. 001] than C. Donor demographics with respect to ages and genders were similar across groups, but AA received more African American donors [C: 11 (7. 5); AA: 31 (28. 4); pO. 0001]. Recipient demographics with respect to age were also similar. but C consisted of more males [C: 95 (64. 6); AA: 56 (51. 4); p<0. 05]. Additional baseline characteristics and outcomes are summarized below.
Conclusions: Elderly African Americans had higher risk baseline and donor characteristics, more pre-transplant HD, greater numbers of deceased donor and expanded criteria donor transplants, and were considered high risk by centers with increased use of ATG and DGF. Despite these factors, the African American group experienced better EGFR at 3 years post-transplant as well as similar long-term BPAR, graft survival, and patient survival outcomes to the Caucasian group.