The relative risk of overall graft loss and acute rejection among African American renal transplant recipients is attenuated with advancing age

Abstract

Graft loss rates are elevated among African American (AA) kidney transplant recipients. This may be attributable to immunological responses, socioeconomic disparities, comorbid conditions and access to care, but it is unclear whether risks are uniform in the AA population. We utilized multivariable models with the national SRTR database for adult recipients transplanted from 2000 to 2009 (n = 112,120) to investigate whether risks of graft loss, death and acute rejection between AAs and Caucasians vary with age. Relative to Caucasians, AA recipients had significantly higher risk of overall graft loss among patients aged 18-49 (AHR = 1.37, 95% CI 1.30-1.43) but comparable risk among patients aged >65 (AHR = 1.04, 95% CI 0.96-1.13). Among recipients aged 18-34, AAs had higher risk of acute rejection (AOR = 1.33, 95% CI 1.12-1.57) but similar likelihood among recipients aged >65 (AOR = 0.94, 95% CI 0.75-1.17). Differences between race groups, as well as the relatively higher risks among younger AAs, were most pronounced following one yr post-transplantation and diminished with presence of other risk factors. Elevated risks of overall graft loss and acute rejection are present among younger but not older AA kidney transplant recipients. These findings may have important implications for treatment decisions, follow-up protocols and designation of "high-risk" patients.