David J Taber1, Mulugeta Gebregziabher, Elizabeth H Payne, Titte Srinivas, Prabhakar K Baliga, Leonard E Egede. 1. 1 Division of Transplant Surgery, College of Medicine, Medical University of South Carolina, Charleston, SC. 2 Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC. 3 Division of Transplant Nephrology, College of Medicine, Medical University of South Carolina, Charleston, SC. 4 Veteran Affairs HSR&D Health Equity and Rural Outreach Innovation Center (HEROIC), Ralph H Johnson VAMC, Charleston, SC.
Abstract
BACKGROUND: Black kidney transplant recipients experience disproportionately high rates of graft loss. This disparity has persisted for 40 years, and improvements may be impeded based on the current public reporting of overall graft loss by US regulatory organizations for transplantation. METHODS: Longitudinal cohort study of kidney transplant recipients using a data set created by linking Veterans Affairs and US Renal Data System information, including 4918 veterans transplanted between January 2001 and December 2007, with follow-up through December 2010. Multivariable analysis was conducted using 2-stage joint modeling of random and fixed effects of longitudinal data (linear mixed model) with time to event outcomes (Cox regression). RESULTS: Three thousand three hundred six non-Hispanic whites (67%) were compared with 1612 non-Hispanic black (33%) recipients with 6.0 ± 2.2 years of follow-up. In the unadjusted analysis, black recipients were significantly more likely to have overall graft loss (hazard ratio [HR], 1.19; 95% confidence interval [95% CI], 1.07-1.33), death-censored graft loss (HR, 1.67; 95% CI, 1.45-1.92), and lower mortality (HR, 0.83; 95% CI, 0.72-0.96). In fully adjusted models, only death-censored graft loss remained significant (HR, 1.38; 95% CI, 1.12-1.71; overall graft loss [HR, 1.08; 95% CI, 0.91-1.28]; mortality [HR, 0.84; 95% CI, 0.67-1.06]). A composite definition of graft loss reduced the magnitude of disparities in blacks by 22%. CONCLUSIONS: Non-Hispanic black kidney transplant recipients experience a substantial disparity in graft loss, but not mortality. This study of US data provides evidence to suggest that researchers should focus on using death-censored graft loss as the primary outcome of interest to facilitate a better understanding of racial disparities in kidney transplantation.
BACKGROUND: Black kidney transplant recipients experience disproportionately high rates of graft loss. This disparity has persisted for 40 years, and improvements may be impeded based on the current public reporting of overall graft loss by US regulatory organizations for transplantation. METHODS: Longitudinal cohort study of kidney transplant recipients using a data set created by linking Veterans Affairs and US Renal Data System information, including 4918 veterans transplanted between January 2001 and December 2007, with follow-up through December 2010. Multivariable analysis was conducted using 2-stage joint modeling of random and fixed effects of longitudinal data (linear mixed model) with time to event outcomes (Cox regression). RESULTS: Three thousand three hundred six non-Hispanic whites (67%) were compared with 1612 non-Hispanic black (33%) recipients with 6.0 ± 2.2 years of follow-up. In the unadjusted analysis, black recipients were significantly more likely to have overall graft loss (hazard ratio [HR], 1.19; 95% confidence interval [95% CI], 1.07-1.33), death-censored graft loss (HR, 1.67; 95% CI, 1.45-1.92), and lower mortality (HR, 0.83; 95% CI, 0.72-0.96). In fully adjusted models, only death-censored graft loss remained significant (HR, 1.38; 95% CI, 1.12-1.71; overall graft loss [HR, 1.08; 95% CI, 0.91-1.28]; mortality [HR, 0.84; 95% CI, 0.67-1.06]). A composite definition of graft loss reduced the magnitude of disparities in blacks by 22%. CONCLUSIONS: Non-Hispanic black kidney transplant recipients experience a substantial disparity in graft loss, but not mortality. This study of US data provides evidence to suggest that researchers should focus on using death-censored graft loss as the primary outcome of interest to facilitate a better understanding of racial disparities in kidney transplantation.
Authors: Marie Chisholm-Burns; Brett Pinsky; Gretchen Parker; Phaedra Johnson; Steven Arcona; Paul Buzinec; Paula Chakravarti; Meg Good; Matthew Cooper Journal: Clin Transplant Date: 2012-02-10 Impact factor: 2.863
Authors: A G Diethelm; E H Blackstone; D C Naftel; S L Hudson; W H Barber; M H Deierhoi; B O Barger; J J Curtis; R G Luke Journal: Ann Surg Date: 1988-05 Impact factor: 12.969
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: Ricardo M La Hoz; Burhaneddin Sandıkçı; Venkatesh K Ariyamuthu; Bekir Tanriover Journal: Am J Transplant Date: 2019-08-07 Impact factor: 8.086
Authors: Kim Peterson; Johanna Anderson; Erin Boundy; Lauren Ferguson; Ellen McCleery; Kallie Waldrip Journal: Am J Public Health Date: 2018-03 Impact factor: 9.308
Authors: David J Taber; James N Fleming; Cory E Fominaya; Mulugeta Gebregziabher; Kelly J Hunt; Titte R Srinivas; Prabhakar K Baliga; John W McGillicuddy; Leonard E Egede Journal: Am J Nephrol Date: 2016-12-02 Impact factor: 3.754
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
Authors: Jesse D Schold; Joshua J Augustine; Anne M Huml; Richard Fatica; Saul Nurko; Alvin Wee; Emilio D Poggio Journal: Am J Transplant Date: 2020-08-27 Impact factor: 8.086
Authors: Karola Warzyszyńska; Michał Zawistowski; Edyta Karpeta; Agnieszka Jałbrzykowska; Maciej Kosieradzki Journal: Ann Transplant Date: 2022-07-26 Impact factor: 1.479
Authors: Franziska A Meister; Zoltan Czigany; Katharina Rietzler; Hannah Miller; Sophie Reichelt; Wen-Jia Liu; Joerg Boecker; Marcus J Moeller; Rene H Tolba; Karim Hamesch; Pavel Strnad; Peter Boor; Christian Stoppe; Ulf P Neumann; Georg Lurje Journal: Sci Rep Date: 2020-10-20 Impact factor: 4.379