TY - JOUR
T1 - Reduced racial disparity in kidney transplant outcomes in the United States from 1990 to 2012
AU - Purnell, Tanjala S.
AU - Luo, Xun
AU - Kucirka, Lauren M.
AU - Cooper, Lisa A.
AU - Crews, Deidra C.
AU - Massie, Allan B.
AU - Boulware, L. Ebony
AU - Segev, Dorry L.
N1 - Funding Information:
ACKNOWLEDGMENTS The authors were supported by grants R01DK096008 (to D.L.S. and T.S.P.), K24DK101828 (to D.L.S.), F30DK095545 (to L.M.K.), and K23DK097184 (to D.C.C.) from the National Institute of Diabetes andDigestive andKidneyDiseases of the National Institutes of Health (NIH) and by grant K24HL083113 (to L.A.C.) from the National Heart, Lung, and Blood Institute of the NIH.
Publisher Copyright:
Copyright © 2016 by the American Society of Nephrology.
PY - 2016
Y1 - 2016
N2 - Earlier studies reported inferior outcomes among black compared with white kidney transplant (KT) recipients.We examined whether this disparity improved in recent decades. Using the Scientific Registry of Transplant Recipients and Cox regressionmodels, we compared all-cause graft loss among 63,910 black and 145,482 white adults who received a first-time live donor KT (LDKT) or deceased donor KT (DDKT) in 1990-2012. Over this period, 5-year graft loss after DDKT improved from 51.4% to 30.6% for blacks and from37.3%to 25.0% for whites; 5-year graft loss after LDKT improved from37.4%to 22.2% for blacks and from 20.8% to 13.9% for whites. Among DDKT recipients in the earliest cohort, blacks were 39% more likely than whites to experience 5-year graft loss (adjusted hazard ratio [aHR], 1.39; 95% confidence interval [95% CI], 1.32 to 1.47; P,0.001), but this disparity narrowed in the most recent cohort (aHR, 1.10; 95% CI, 1.03 to 1.18; P=0.01). Among LDKT recipients in the earliest cohort, blacks were 53% more likely than whites to experience 5-year graft loss (aHR, 1.53; 95% CI, 1.27 to 1.83; P,0.001), but this disparity also narrowed in the most recent cohort (aHR, 1.37; 95% CI, 1.17 to 1.61; P,0.001). Analyses revealed no statistically significant differences in 1-year or 3-year graft loss after LDKT or DDKT in the most recent cohorts. Our findings of reduced disparities over the last 22 years driven by more markedly improved outcomes for blacks may encourage nephrologists and patients to aggressively promote access to transplantation in the black community.
AB - Earlier studies reported inferior outcomes among black compared with white kidney transplant (KT) recipients.We examined whether this disparity improved in recent decades. Using the Scientific Registry of Transplant Recipients and Cox regressionmodels, we compared all-cause graft loss among 63,910 black and 145,482 white adults who received a first-time live donor KT (LDKT) or deceased donor KT (DDKT) in 1990-2012. Over this period, 5-year graft loss after DDKT improved from 51.4% to 30.6% for blacks and from37.3%to 25.0% for whites; 5-year graft loss after LDKT improved from37.4%to 22.2% for blacks and from 20.8% to 13.9% for whites. Among DDKT recipients in the earliest cohort, blacks were 39% more likely than whites to experience 5-year graft loss (adjusted hazard ratio [aHR], 1.39; 95% confidence interval [95% CI], 1.32 to 1.47; P,0.001), but this disparity narrowed in the most recent cohort (aHR, 1.10; 95% CI, 1.03 to 1.18; P=0.01). Among LDKT recipients in the earliest cohort, blacks were 53% more likely than whites to experience 5-year graft loss (aHR, 1.53; 95% CI, 1.27 to 1.83; P,0.001), but this disparity also narrowed in the most recent cohort (aHR, 1.37; 95% CI, 1.17 to 1.61; P,0.001). Analyses revealed no statistically significant differences in 1-year or 3-year graft loss after LDKT or DDKT in the most recent cohorts. Our findings of reduced disparities over the last 22 years driven by more markedly improved outcomes for blacks may encourage nephrologists and patients to aggressively promote access to transplantation in the black community.
UR - http://www.scopus.com/inward/record.url?scp=85015478860&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85015478860&partnerID=8YFLogxK
U2 - 10.1681/ASN.2015030293
DO - 10.1681/ASN.2015030293
M3 - Article
C2 - 26848153
AN - SCOPUS:85015478860
VL - 27
SP - 2511
EP - 2518
JO - Journal of the American Society of Nephrology : JASN
JF - Journal of the American Society of Nephrology : JASN
SN - 1046-6673
IS - 8
ER -