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J Am Soc Nephrol. 2016 Aug;27(8):2511-8. doi: 10.1681/ASN.2015030293. Epub 2016 Feb 4.

Reduced Racial Disparity in Kidney Transplant Outcomes in the United States from 1990 to 2012.

Author information

1
Division of Transplantation, Department of Surgery, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; and Johns Hopkins Center to Eliminate Cardiovascular Health Disparities, dorry@jhmi.edu tpurnel1@jhmi.edu.
2
Division of Transplantation, Department of Surgery.
3
Division of Transplantation, Department of Surgery, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; and.
4
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; and Johns Hopkins Center to Eliminate Cardiovascular Health Disparities, Division of General Internal Medicine, and.
5
Johns Hopkins Center to Eliminate Cardiovascular Health Disparities, Division of Nephrology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland;
6
Division of General Internal Medicine, Duke University School of Medicine, Durham, North Carolina.

Abstract

Earlier studies reported inferior outcomes among black compared with white kidney transplant (KT) recipients. We examined whether this disparity improved in recent decades. Using the Scientific Registry of Transplant Recipients and Cox regression models, we compared all-cause graft loss among 63,910 black and 145,482 white adults who received a first-time live donor KT (LDKT) or deceased donor KT (DDKT) in 1990-2012. Over this period, 5-year graft loss after DDKT improved from 51.4% to 30.6% for blacks and from 37.3% to 25.0% for whites; 5-year graft loss after LDKT improved from 37.4% to 22.2% for blacks and from 20.8% to 13.9% for whites. Among DDKT recipients in the earliest cohort, blacks were 39% more likely than whites to experience 5-year graft loss (adjusted hazard ratio [aHR], 1.39; 95% confidence interval [95% CI], 1.32 to 1.47; P<0.001), but this disparity narrowed in the most recent cohort (aHR, 1.10; 95% CI, 1.03 to 1.18; P=0.01). Among LDKT recipients in the earliest cohort, blacks were 53% more likely than whites to experience 5-year graft loss (aHR, 1.53; 95% CI, 1.27 to 1.83; P<0.001), but this disparity also narrowed in the most recent cohort (aHR, 1.37; 95% CI, 1.17 to 1.61; P<0.001). Analyses revealed no statistically significant differences in 1-year or 3-year graft loss after LDKT or DDKT in the most recent cohorts. Our findings of reduced disparities over the last 22 years driven by more markedly improved outcomes for blacks may encourage nephrologists and patients to aggressively promote access to transplantation in the black community.

KEYWORDS:

Epidemiology; and outcomes; end-stage renal disease; ethnicity; kidney transplantation; transplant outcomes

PMID:
26848153
PMCID:
PMC4978037
DOI:
10.1681/ASN.2015030293
[Indexed for MEDLINE]
Free PMC Article

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