Racial disparity in kidney transplant survival relates to late rejection and is independent of steroid withdrawal. Issue 9 (30th August 2018)

• Record Type: Journal Article
• Authors: Liu, Angela; Woodside, Kenneth J.; Augustine, Joshua J.; Sarabu, Nagaraju
• Is Part Of: Clinical transplantation. Volume 32:Issue 9(2018)
• Page Start: n/a
• Page End: n/a
• Publication Date: 2018-08-30
• Subjects: acute rejection -- African American -- early steroid withdrawal -- graft survival -- kidney transplant; Transplantation of organs, tissues, etc -- Periodicals; 617.95
• DOI: 10.1111/ctr.13381
• Languages: English
• ISSNs: 0902-0063

Abstract

Abstract: Black kidney transplant recipients have more acute rejection (AR) and inferior graft survival. We sought to determine whether early steroid withdrawal (ESW) had an impact on AR and death‐censored graft loss (DCGL) in blacks. From 2006 to 2012, AR and graft survival were analyzed in 483 kidney recipients (208 black and 275 non‐black). Rates of ESW were similar between blacks (65%) and non‐blacks (67%). AR was defined as early (≤3 months) or late (>3 months). The impact of black race, early AR, and late AR on death‐censored graft failure was analyzed using univariate and multivariate Cox models. Blacks had greater dialysis vintage, more deceased donor transplants, and less HLA matching, yet rates of early AR were comparable between blacks and non‐blacks. However, black race was a risk factor for late AR (HR: 3.48 (95% CI: 1.87‐6.47)) Blacks had a greater rate of DCGL, partially driven by late AR (HR with late AR: 5.6; 95% CI: 3.3‐9.3). ESW had no significant interaction with black race for risk of early AR, late AR, or DCGL. Independent of ESW, black kidney recipients had a higher rate of late AR after kidney transplantation. Late AR was highly predictive of DCGL and contributed to inferior graft survival in blacks.