Effect of Donor and Recipient Gender/Race Disparity On Kidney Transplant Outcomes.

Abstract

Background: The influence of donor/recipient gender and race in kidney transplantation on graft and patient outcomes is still controversial, with a lack of consensus in the reported literature. The aim of this study is evaluate the effect of gender and racial disparities on outcomes in deceased donor kidney transplant recipients. Methods: This was a retrospective analysis of deceased donor kidney transplants performed between 2005 and 2010. All patients received calcineurin inhibitor based immunosuppression with patients followed for up to 5 years post-transplant. Donor and recipient race stratification was limited to African American (AA) and Caucasian (C). Three year graft and patient survival, acute rejection rates, and renal function (e12, 24, and 36 month) were reported. Multivariate analysis will be performed. Results: A total of 261 consecutives deceased donor renal transplant were stratified into the following groups: donor AA to recipient C (n=21), AA to AA (n=61), C to AA (n=118), and C to C (n=61). Mean follow up time was 4.1+/- 1.8 years. Three year death censored graft function for each group was worse in AA recipients (AA to C 94.7%; AA to AA 86.8%; C to C 93.4%; and C to AA 90.7%). Three year patient survival for each group demonstrate worse survival in the C to AA patients (AA to C 94.7%; AA to AA 95.1%; C to C 93.4%; and C to AA 89%). Three year acute rejection rates were comparable between groups: AA to C 5.3%; AA to AA 6.6%; C to C 13.1%; and C to AA 11.9%. Renal function as determined by the estimated glomerular filtration rates (ml/min/1.73m2) was similar between groups at 12 months (AA to C 51±24, AA to AA 51±21, C to AA 57±22, C to C 53±17), at 24 months (AA to C 62±26, AA to AA 53±25, C to AA 58±21, C to C 47±17), and at 36 months (AA to C 54±27, AA to AA 44±22, C to AA 54±26, C to C 47±16). Stratifying by both gender and race demonstrated that 3 year death censored graft survival was worse in AA female donors to AA recipients (male: 81.0% and female 81.8 %) as compared to the other donor groups. Conclusions: Preliminary results suggest that AA kidney transplant recipients have impaired clinical outcomes regardless of donor race/gender. However, AA kidney transplant recipients (regardless of gender) from female AA donors appear to have worse graft function at 3 years as compared to other donor types. Additional analysis is needed to further evaluate this relationship.