BACKGROUND: There is continued and significant debate regarding the salient etiologies associated with graft loss and racial disparities in kidney transplant recipients. METHODS: This was a longitudinal cohort study of all adult kidney transplant recipients, comparing patients with early graft loss (<5 years) to those with graft longevity (surviving graft with at least 5 years of follow-up) across racial cohorts [African-American (AA) and non-AA] to discern risk factors. RESULTS: 524 patients were included, 55% AA, 151 with early graft loss (29%) and 373 with graft longevity (71%). Consistent within both races, early graft loss was significantly associated with disability income [adjusted odds ratio (AOR) 2.2, 95% CI 1.1-4.5], Kidney Donor Risk Index (AOR 3.2, 1.4-7.5), rehospitalization (AOR 2.1, 1.0-4.4) and acute rejection (AOR 4.4, 1.7-11.6). Unique risk factors in AAs included Medicare-only insurance (AOR 8.0, 2.3-28) and BK infection (AOR 5.6, 1.3-25). Unique protective factors in AAs included cardiovascular risk factor control: AAs with a mean systolic blood pressure <150 mm Hg had 80% lower risk of early graft loss (AOR 0.2, 0.1-0.7), while low-density lipoprotein <100 mg/dl (AOR 0.4, 0.2-0.8), triglycerides <150 mg/dl (AOR 0.4, 0.2-1.0) and hemoglobin A1C <7% (AOR 0.2, 0.1-0.6) were also protective against early graft loss in AA, but not in non-AA recipients. CONCLUSIONS: AA recipients have a number of unique risk factors for early graft loss, suggesting that controlling cardiovascular comorbidities may be an important mechanism to reduce racial disparities in kidney transplantation.
BACKGROUND: There is continued and significant debate regarding the salient etiologies associated with graft loss and racial disparities in kidney transplant recipients. METHODS: This was a longitudinal cohort study of all adult kidney transplant recipients, comparing patients with early graft loss (<5 years) to those with graft longevity (surviving graft with at least 5 years of follow-up) across racial cohorts [African-American (AA) and non-AA] to discern risk factors. RESULTS: 524 patients were included, 55% AA, 151 with early graft loss (29%) and 373 with graft longevity (71%). Consistent within both races, early graft loss was significantly associated with disability income [adjusted odds ratio (AOR) 2.2, 95% CI 1.1-4.5], Kidney Donor Risk Index (AOR 3.2, 1.4-7.5), rehospitalization (AOR 2.1, 1.0-4.4) and acute rejection (AOR 4.4, 1.7-11.6). Unique risk factors in AAs included Medicare-only insurance (AOR 8.0, 2.3-28) and BK infection (AOR 5.6, 1.3-25). Unique protective factors in AAs included cardiovascular risk factor control: AAs with a mean systolic blood pressure <150 mm Hg had 80% lower risk of early graft loss (AOR 0.2, 0.1-0.7), while low-density lipoprotein <100 mg/dl (AOR 0.4, 0.2-0.8), triglycerides <150 mg/dl (AOR 0.4, 0.2-1.0) and hemoglobin A1C <7% (AOR 0.2, 0.1-0.6) were also protective against early graft loss in AA, but not in non-AA recipients. CONCLUSIONS: AA recipients have a number of unique risk factors for early graft loss, suggesting that controlling cardiovascular comorbidities may be an important mechanism to reduce racial disparities in kidney transplantation.
Authors: Fernando G Cosio; Todd E Pesavento; Sunny Kim; Kwame Osei; Mitchell Henry; Ronald M Ferguson Journal: Kidney Int Date: 2002-10 Impact factor: 10.612
Authors: F G Cosio; J J Dillon; M E Falkenhain; R J Tesi; M L Henry; E A Elkhammas; E A Davies; G L Bumgardner; R M Ferguson Journal: Kidney Int Date: 1995-04 Impact factor: 10.612
Authors: David J Taber; Mulugeta Gebregziabher; Elizabeth H Payne; Titte Srinivas; Prabhakar K Baliga; Leonard E Egede Journal: Transplantation Date: 2017-02 Impact factor: 4.939
Authors: David J Taber; Kelly J Hunt; Cory E Fominaya; Elizabeth H Payne; Mulugeta Gebregziabher; Titte R Srinivas; Prabhakar K Baliga; Leonard E Egede Journal: Hypertension Date: 2016-07-11 Impact factor: 10.190
Authors: David J Taber; Kelly J Hunt; Mulugeta Gebregziabher; Titte Srinivas; Kenneth D Chavin; Prabhakar K Baliga; Leonard E Egede Journal: Clin J Am Soc Nephrol Date: 2016-12-15 Impact factor: 8.237
Authors: David J Taber; Mahsa Hamedi; James R Rodrigue; Mulugeta G Gebregziabher; Titte R Srinivas; Prabhakar K Baliga; Leonard E Egede Journal: Transplantation Date: 2016-07 Impact factor: 4.939
Authors: Sharad Indur Wadhwani; Evelyn K Hsu; Michele L Shaffer; Ravinder Anand; Vicky Lee Ng; John C Bucuvalas Journal: Pediatr Transplant Date: 2019-07-22
Authors: David J Taber; Zemin Su; James N Fleming; John W McGillicuddy; Maria A Posadas-Salas; Frank A Treiber; Derek Dubay; Titte R Srinivas; Patrick D Mauldin; William P Moran; Prabhakar K Baliga Journal: Transplantation Date: 2017-12 Impact factor: 4.939