Impact of race on renal transplant outcome

I. J A Dawidson, L. Coorpender, D. Fisher, H. Helderman, A. Hull, Biff F Palmer, P. Peters, Arthur I Sagalowsky, Z. F. Sandor, Robert D Toto, Joan S Reisch

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

The influence of race on the outcome of cadaver renal transplantation (CRT) continues to be controversial even in the cyclosporine era. The present study examines the effect of race in 343 adult CRT performed from 1/1/82 through 10/1/88 with regard to the incidence of delayed function (DF), graft survival (GS), and patient survival (PS). Blacks constituted 38% of the patients. A history of nephrosclerosis secondary to hypertension was more common in blacks, with 51% (67/130) vs. 8% (17/213) in whites, while glomerulonephritis and Type 1 diabetes mellitus were more common in whites. There was no significant difference in the number of HLA (A,B,DR) matches or DR mismatches between whites and blacks. With azathioprine immunosuppression DF was more common in blacks than in whites, 54% (14/26) vs. 20% (11/55) respectively (P<0.01). The higher incidence of DF in blacks than in whites on Aza was associated with a significantly lower dose of intraoperative albumin, 0.25 g/kg vs. 0.44 g/kg, respectively (P<0.01). Of the Aza treated black recipients who had DF, 79% (11/14) had graft loss within three months, significantly worse than 25% (3/12) with graft loss when immediate function was present (P<0.005). Currently, all patients receive at least 0.80 g/kg of albumin intraoperatively and CsA quadruple induction therapy. With the current regimen, black and white recipients of primary CRT recipients have a comparable low incidence of DF of 18% and 22%, respectively. However, DF remains high among repeat black or white recipients: 33% (10/30) and 57% (8/14), respectively. The incidence of rejection within 30 days was similar for black and white recipients during the Aza and CsA eras, 62% vs. 75% and 34% vs. 42% respectively. GS and PS at three months for blacks on Aza were 54% and 89%, respectively, reflecting the corresponding high incidence of DF. This compares with 71% and 97% GS and PS for whites on Aza. Blacks and whites receiving CsA had equivalent 1-year GS and PS: 76% and 92%, respectively. We conclude that, in our center during the Aza era, blacks had a higher incidence of DF and lower GS than whites. With our current intraoperative fluid replacement and CsA immunosuppression, the incidence of DF and GS and PS are equivalent in black and white recipients.

Original languageEnglish (US)
Pages (from-to)63-67
Number of pages5
JournalTransplantation
Volume49
Issue number1
StatePublished - 1990

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Graft Survival
Transplants
Kidney
Incidence
Cadaver
Survival
Kidney Transplantation
Immunosuppression
Albumins
Nephrosclerosis
HLA-A Antigens
HLA-B Antigens
hydroquinone
Azathioprine
Glomerulonephritis
Type 1 Diabetes Mellitus
Cyclosporine
Hypertension

ASJC Scopus subject areas

  • Immunology
  • Transplantation

Cite this

Dawidson, I. J. A., Coorpender, L., Fisher, D., Helderman, H., Hull, A., Palmer, B. F., ... Reisch, J. S. (1990). Impact of race on renal transplant outcome. Transplantation, 49(1), 63-67.

Impact of race on renal transplant outcome. / Dawidson, I. J A; Coorpender, L.; Fisher, D.; Helderman, H.; Hull, A.; Palmer, Biff F; Peters, P.; Sagalowsky, Arthur I; Sandor, Z. F.; Toto, Robert D; Reisch, Joan S.

In: Transplantation, Vol. 49, No. 1, 1990, p. 63-67.

Research output: Contribution to journalArticle

Dawidson, IJA, Coorpender, L, Fisher, D, Helderman, H, Hull, A, Palmer, BF, Peters, P, Sagalowsky, AI, Sandor, ZF, Toto, RD & Reisch, JS 1990, 'Impact of race on renal transplant outcome', Transplantation, vol. 49, no. 1, pp. 63-67.
Dawidson IJA, Coorpender L, Fisher D, Helderman H, Hull A, Palmer BF et al. Impact of race on renal transplant outcome. Transplantation. 1990;49(1):63-67.
Dawidson, I. J A ; Coorpender, L. ; Fisher, D. ; Helderman, H. ; Hull, A. ; Palmer, Biff F ; Peters, P. ; Sagalowsky, Arthur I ; Sandor, Z. F. ; Toto, Robert D ; Reisch, Joan S. / Impact of race on renal transplant outcome. In: Transplantation. 1990 ; Vol. 49, No. 1. pp. 63-67.
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AU - Dawidson, I. J A

AU - Coorpender, L.

AU - Fisher, D.

AU - Helderman, H.

AU - Hull, A.

AU - Palmer, Biff F

AU - Peters, P.

AU - Sagalowsky, Arthur I

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AU - Reisch, Joan S

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N2 - The influence of race on the outcome of cadaver renal transplantation (CRT) continues to be controversial even in the cyclosporine era. The present study examines the effect of race in 343 adult CRT performed from 1/1/82 through 10/1/88 with regard to the incidence of delayed function (DF), graft survival (GS), and patient survival (PS). Blacks constituted 38% of the patients. A history of nephrosclerosis secondary to hypertension was more common in blacks, with 51% (67/130) vs. 8% (17/213) in whites, while glomerulonephritis and Type 1 diabetes mellitus were more common in whites. There was no significant difference in the number of HLA (A,B,DR) matches or DR mismatches between whites and blacks. With azathioprine immunosuppression DF was more common in blacks than in whites, 54% (14/26) vs. 20% (11/55) respectively (P<0.01). The higher incidence of DF in blacks than in whites on Aza was associated with a significantly lower dose of intraoperative albumin, 0.25 g/kg vs. 0.44 g/kg, respectively (P<0.01). Of the Aza treated black recipients who had DF, 79% (11/14) had graft loss within three months, significantly worse than 25% (3/12) with graft loss when immediate function was present (P<0.005). Currently, all patients receive at least 0.80 g/kg of albumin intraoperatively and CsA quadruple induction therapy. With the current regimen, black and white recipients of primary CRT recipients have a comparable low incidence of DF of 18% and 22%, respectively. However, DF remains high among repeat black or white recipients: 33% (10/30) and 57% (8/14), respectively. The incidence of rejection within 30 days was similar for black and white recipients during the Aza and CsA eras, 62% vs. 75% and 34% vs. 42% respectively. GS and PS at three months for blacks on Aza were 54% and 89%, respectively, reflecting the corresponding high incidence of DF. This compares with 71% and 97% GS and PS for whites on Aza. Blacks and whites receiving CsA had equivalent 1-year GS and PS: 76% and 92%, respectively. We conclude that, in our center during the Aza era, blacks had a higher incidence of DF and lower GS than whites. With our current intraoperative fluid replacement and CsA immunosuppression, the incidence of DF and GS and PS are equivalent in black and white recipients.

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