Faculty Collaboration Database

Overall Graft Loss Versus Death-Censored Graft Loss: Unmasking the Magnitude of Racial Disparities in Outcomes Among US Kidney Transplant Recipients. Transplantation 2017 Feb;101(2):402-410

Date

02/24/2016

Pubmed ID

26901080

Pubmed Central ID

PMC4991956

DOI

10.1097/TP.0000000000001119

Scopus ID

2-s2.0-84959164706 (requires institutional sign-in at Scopus site)   23 Citations

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.

Author List

Taber DJ, Gebregziabher M, Payne EH, Srinivas T, Baliga PK, Egede LE

Author

Leonard E. Egede MD Center Director, Chief, Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Aged
Chi-Square Distribution
Databases, Factual
Female
Graft Survival
Health Status Disparities
Healthcare Disparities
Humans
Kaplan-Meier Estimate
Kidney Transplantation
Longitudinal Studies
Male
Middle Aged
Multivariate Analysis
Odds Ratio
Proportional Hazards Models
Quality Indicators, Health Care
Retrospective Studies
Risk Factors
Time Factors
Treatment Outcome
United States
United States Department of Veterans Affairs