The racial gap has narrowed in U.S. kidney transplant graft loss

Last Updated: 2016-02-11

By Rita Buckley

NEW YORK (Reuters Health) - The racial gap in all-cause graft loss after live or deceased donor kidney transplants has narrowed over 22 years, underscoring a need to improve access to transplantation for black patients with end-stage renal disease, researchers say.

Dr. Dorry Segev from Johns Hopkins Medical Institutions in Baltimore, and colleagues investigated outcome differences in all-cause graft loss after kidney transplantation among 63,910 black and 145,482 white adults between 1990 and 2012.

The earliest cohort received transplants in 1990-1992. The data for five-year outcomes came from that group plus patients who received transplants in 2007-2008. Three-year outcome comparisons come from 2009-2010, and one-year outcome comparisons come from 2011-2012, according to an article online February 4 in the Journal of the American Society of Nephrology.

In the earliest cohort, blacks were 53% more likely than whites to experience five-year graft loss, but blacks were 37% more likely to in the more recent five-year cohort. Blacks in the early cohort were 44% more likely to experience three-year graft loss but researchers found no significant differences in the most recent three-year group. They also found no significant differences between blacks and whites in the one-year outcomes.

Among deceased donor transplant recipients in the earliest cohort, blacks were 39% (p<0.001) more likely than whites to experience five-year graft loss, while blacks in the more recent five-year group were 10% more likely. Among these recipients, blacks were 30% more likely to experience three-year graft loss.

Among living donor kidney transplant recipients in the earliest cohort, blacks were 53% (p<0.001) more likely than whites to experience five-year graft loss, but this disparity narrowed to 37% (p<0.001) in the more recent cohort.

The researchers found no statistically significant racial differences in one- or three-year graft loss after living or deceased donor transplants for the more recent cohorts.

Dr. Martha Pavlakis, medical director of kidney and pancreas transplantation at Beth Israel Deaconess Medical Center in Boston, who was not involved in the study, said that the report is extremely important.

According to Dr. Pavlakis, the improvements resulted from some fundamental medication and policy changes in the intervening two decades.

The researchers cited immunosuppression advances that improved outcomes in all transplant patients, especially blacks; changes in the deceased donor organ allocation policy, such as the 2003 elimination of priority HLA-B matching; and two major Medicare policy initiatives.

"Data from this study should dispel any misguided residual hesitancy on the part of referring physicians to recommend transplantation to their black patients with kidney disease or hesitancy on the part of black patients to pursue kidney transplantation," said Dr. Pavlakis.

Despite the main limitation of any large data set -- lack of granularity -- the importance of the findings cannot be overestimated, she said.

"The study vindicates the numerous changes undertaken over the years by national agencies, . . . as well as research and science-based advances to improve post-transplant care," said Dr. Pavlakis.

In an email to Reuters Health, Dr. Segev said that the findings reflect changes in the transplant community that show a better understanding of the immune system and how to keep patients from having rejection episodes, developing donor-specific antibodies, and losing their transplants.

"Some of these challenges have been specific to African American patients," he said, noting that improvements over time eliminated outcome disparities that existed in the past.

The researchers reported no funding or disclosures.

SOURCE: http://bit.ly/20YaBtI

J Am Soc Nephrol 2016