Pancreas Transplantation in African American Compared to Non African American Patients: Does Recipient Ethnicity Influence Outcomes?

Abstract

The influence of African American (AA) recipient ethnicity on outcomes following pancreas transplantation (PT) is uncertain. Methods: We retrospectively studied 202 consecutive PTs in 192 patients at our center. All patients received either rATG or alemtuzumab induction with tacrolimus, MMF, and tapered steroids. Results: From 11/01 to 3/13, 39 PTs (36 simultaneous pancreas-kidney) were performed in AA recipients and 163 in non AA recipients (161 Caucasian). The AA group had fewer solitary PTs (8% AA versus 23% non AA), more PTs performed with systemic-enteric drainage (23% AA versus 9% non AA), more sensitized patients (28% AA versus 10% non AA), more 5-6 HLA mismatches (64% AA versus 42% non AA), more patients ≥80 kg (51% AA versus 24% non AA), more patients with detectable pretransplant C-peptide levels (36% AA versus 14% non AA), and more patients with a shorter duration (≤18years) of pretransplant diabetes (38% AA versus 17% non AA, all p<0.05). The latter 3 differences suggested that a type 2 diabetes phenotype was more prevalent in the AA group. With a mean follow-up of 5.5 years, overall patient (90% AA versus 86.5% non AA), kidney (67% AA versus 77% non AA) and pancreas graft survival (59% AA versus 67 % non AA) rates were comparable. The rates of early thrombosis were 10% versus 7%, while cumulative clinical acute rejection rates were 33% versus 27% in the AA and non AA groups, respectively. However, the incidences of death-censored kidney graft loss (30% AA versus 13% non AA) and dual graft loss (22% AA versus 6% non AA, both p<0.05) were much higher in AA patients. Conclusions: PT in AA recipients is characterized by fewer solitary PTs and more PTs with systemic-enteric drainage, more sensitized patients and HLA-mismatching, and more patients with a type 2 diabetes phenotype. Although survival rates and the incidences of early thrombosis and acute rejection are similar, AA patients are at a greater risk for both isolated kidney and dual graft loss in the absence of mortality.