17-OR

Abstract

Published studies have suggested that African Americans (AA) have reduced long term kidney transplant (KT) survival compared to non AA. OPTN/SRTR registry data (1998 – 2007) indicate that 10 year deceased donor (DD) KT survival is significantly less for AA, 34.6%, compared to Caucasians, 45.8%. In this 10 year single center study of DD KT we examined factors that might account for significant differences in transplant outcomes among racial groups. The study population consisted of 426 (307 AA, 119 non AA) consecutive recipients that received DD KT at our center from January 1, 1998 to December 31, 2007. All recipients had negative T cell CDCXMs (Amos). FCXMs with the pre transplant CDCXM negative sera were performed within 48 hrs of transplantation. Immunosuppression: Induction with Thymoglobulin, maintenance therapy, Tacrolimus, MMF, prednisone. End point: Graft failure with return to dialysis. DD KT survival in T- B- FCXM AA recipients was 84.4% (n = 237) which was similar to non AA, 86.2% (n = 87). The latter outcomes were significantly better (p = 0.001) then AA and non AA with T- B+ FCXMs, 44.4% (n = 27) and 50.0% (n = 12), respectively. However, there was a difference in graft survival for AA with T+ B+ FCXMs, 55.8% (n = 43) compared to non AA 80% (n = 20). Multivariate analyses (COX HR) of the study population (n = 426) indicated that DD age but not race was a risk factor for DD KT survival as there was a significant difference in the age (42.8) of DD to AA compared to the age (38.3) of DD to non AA. In contrast to registry data, our 10 year study indicated that DD KT survival in AA was slightly less but not significantly different then KT survival in non AA though a difference was detected, respectively, in T+ B+ FCXM groups. Differences in transplant outcomes among racial groups may be observed if the following factors are not considered: presence of low levels of donor specific antibody (by FCXM and/or SAB), donor age and use of induction therapy. Norin: Immucor - Lifecodes: Speakers Bureau.