A comparison of kidney transplant survival in white and black recipients.

This study was an analysis of graft survival in patients transplanted during the 1984 to 1988 cyclosporine era. 1. The 1-year first cadaver donor graft survival rate was 77 in whites and 70 in blacks. This difference increased by the third year to 65 in whites and 49 in blacks. 2. The corresponding second graft survival was 67 for whites and 60 for blacks in the first year and 53 for whites and 39 for blacks in the third year. 3. The same graft survival was noted in whites for patients older than 15. For blacks, the 3-year survival for older patients (over 45 years of age) was higher (50%) than for those 15 to 30 years old (43%). 4. The yearly trend for whites has been that older patients have had graft survival equivalent to young patients. However, among blacks, survival in young patients did not improve with the introduction of cyclosporine, and survival of older blacks was the same as for older whites. 5. The difference in graft survival between whites and blacks was greater for young males than females. 6. In both races, immunologic failures occurred more often in young patients than in older ones. 7. Patients with various original diseases consistently showed superior survival in whites as compared to blacks. Only in SLE patients did blacks have higher survival rates. 8. The half-life of transplants in blacks was lower than in whites in the 1974 to 1979 period as well as from 1980 to 1988. The half-life was about 8 years in whites and about 4 years in blacks. 9. Parental donor and HLA-identical sibling donor grafts in blacks had about the same graft survival as corresponding grafts in whites. Thus, when the HLA chromosome had been matched, the race effect disappeared. 10. We postulate that noncompliance may have been the major factor resulting in lower graft survival in young black males. A suggested ideal solution to the problem is recruitment of more black cadaver donors in order to achieve excellent matches.