Faculty Collaboration Database

Significant racial differences in the key factors associated with early graft loss in kidney transplant recipients. Am J Nephrol 2014;40(1):19-28

Date

06/28/2014

Pubmed ID

24969370

Pubmed Central ID

PMC4125570

DOI

10.1159/000363393

Scopus ID

2-s2.0-84902915724 (requires institutional sign-in at Scopus site)   21 Citations

Abstract

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.

Author List

Taber DJ, Douglass K, Srinivas T, McGillicuddy JW, Bratton CF, Chavin KD, 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
BK Virus
Cardiovascular Diseases
Cohort Studies
Dyslipidemias
Female
Graft Rejection
Graft Survival
Health Status Disparities
Humans
Hypertension
Immunosuppressive Agents
Kidney Failure, Chronic
Kidney Transplantation
Longitudinal Studies
Male
Medicare
Middle Aged
Mycophenolic Acid
Odds Ratio
Polyomavirus Infections
Prednisone
Retrospective Studies
Risk Factors
Tacrolimus
Time Factors
United States