EPIDEMIOLOGY AND CLINICAL OUTCOMES

J. Mcgee¹, L.P. Chou¹, A. Harbin², Y. Hsueh³, C.L. Yau⁴, D.P. Slakey^1
1Surgery, Tulane University School of Medicine, New Orleans/LA/UNITED STATES OF AMERICA, ²Surgery, Tulane University School of Medicine, New Orleans/UNITED STATES OF AMERICA, ³Biostatistics, Tulane University School of Public Health and Tropical Medicine, New Orleans/UNITED STATES OF AMERICA, ⁴Biostatistics, Tulane University School of Public Health and Tropical Medicine, New Orleans/LA/UNITED STATES OF AMERICA

Body: Introduction African Americans (AAs) have been characterized as high-risk primary graft recipients. It is assumed that AA race is a risk for poor outcomes after re-transplantation. We aimed to describe patient and graft survival by race after multiple transplants. Methods 178,173 records from the Scientific Registry of Transplant Recipients were retrospectively reviewed from 1987 until 2006. Kaplan-Meier estimates of patient and graft survival after second and third kidney transplant were performed. Cox proportional hazards of graft loss were calculated. Results 48,515 recipients were AAs, and 129,658 were Caucasians (CAs). 7.4% received a second transplant, 24% AAs and 76% CAs (p<0.05). After second transplant compared to CAs, AAs had significantly worse patient and graft survival for the entire observational period (log-rank p<0.0001). 0.5% of patients received a third transplant, 17% AAs and 83% CAs (p<0.0001). After third transplant compared to CAs, AAs had significantly lower patient and graft survival (log-rank p=0.0016). Multivariate adjustment showed donor age (hazard ratio [HR] 1.013, p<0.0001), HLA mismatch (HR 1.58, p=0.0215), acute rejection (HR 1.54, p<0.0001), and AA race (HR 1.4, p<0.0001) were risks of graft loss after second transplant. Similar modeling after third transplant failed to demonstrate any significant risk factors and showed a decreased hazard when donor body mass index was >30 kg/m² (HR 0.35, p=0.04). Conclusion After second and third kidney transplant compared to CAs, AAs have significantly worse patient and graft survival. AA race is a risk factor of graft loss after second transplant. Disparity research in kidney transplantation should include investigations in outcome beyond the primary transplantation.

Disclosure: All authors have declared no conflicts of interest.