Similar outcomes among black and white renal allograft recipients.

Black renal transplant recipients experience shorter graft survival than white recipients, but no published data describe the graft outcomes among black Canadian recipients. Here, we analyzed data from the Canadian national renal replacement therapy registry, which included 20,243 incident dialysis patients (3% black, 97% white), 5036 of whom received a renal transplant during the study period. Black patients were significantly less likely to receive a renal transplant (deceased and living-donor combined) when compared with white patients (hazard ratio 0.59; 95% confidence interval 0.51 to 0.69; P < 0.0001). Among patients who underwent a renal transplant, there was no significant difference in the likelihood of graft failure between black and white patients, even after adjustment for comorbidities and socioeconomic status; black patients, however, had significantly lower posttransplantation mortality compared with white patients (hazard ratio 0.49; 95% confidence interval 0.28 to 0.88; P = 0.02). In conclusion, graft outcomes between black and white Canadian renal transplant patients are similar. Because this differs from the experience reported from the United States, further direct comparisons between the two populations is warranted.

[1]  M. Schnitzler,et al.  Income‐Related Disparities in Kidney Transplant Graft Failures Are Eliminated by Medicare's Immunosuppression Coverage , 2008, American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons.

[2]  W. Braun,et al.  Assessing Glomerular Filtration Rate by Estimation Equations in Kidney Transplant Recipients , 2006, American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons.

[3]  D. Schaubel,et al.  Mortality After Kidney Transplantation: A Comparison Between the United States and Canada , 2006, American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons.

[4]  N. Pallet,et al.  Kidney Transplant in Black Recipients: Are African Europeans Different from African Americans? , 2005, American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons.

[5]  R. Barr,et al.  Race/Ethnicity, Poverty Status, and Renal Transplant Outcomes , 2005, Transplantation.

[6]  Keith C. Norris,et al.  Unraveling the racial disparities associated with kidney disease. , 2005, Kidney international.

[7]  A. Israni,et al.  Race and electronically measured adherence to immunosuppressive medications after deceased donor renal transplantation. , 2005, Journal of the American Society of Nephrology : JASN.

[8]  L. Lahman,et al.  Kidney transplants in African Americans and non-African Americans: equivalent outcomes with living but not deceased donors. , 2005, Transplantation proceedings.

[9]  A. Cass,et al.  Access to renal transplantation for minority patients with ESRD in Canada. , 2004, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[10]  K. Johansen,et al.  Influence of race on kidney transplant outcomes within and outside the Department of Veterans Affairs. , 2004, Journal of the American Society of Nephrology : JASN.

[11]  M. Tonelli,et al.  Death and renal transplantation among Aboriginal people undergoing dialysis , 2004, Canadian Medical Association Journal.

[12]  P. Cleary,et al.  Physicians' beliefs about racial differences in referral for renal transplantation. , 2004, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[13]  A. Farney,et al.  A Decade of Experience With Renal Transplantation in African-Americans , 2002, Annals of surgery.

[14]  T. Theruvath,et al.  Strategies to improve long-term outcomes after renal transplantation. , 2002, The New England journal of medicine.

[15]  R. Stratta,et al.  Renal allograft outcomes in African American versus Caucasian transplant recipients in the tacrolimus era. , 2001, Surgery.

[16]  C. Young,et al.  Renal transplantation in black Americans. , 2000, The New England journal of medicine.

[17]  S. Hariharan,et al.  Improved graft survival after renal transplantation in the United States, 1988 to 1996. , 2000, The New England journal of medicine.

[18]  P. Cleary,et al.  The effect of patients' preferences on racial differences in access to renal transplantation. , 1999, The New England journal of medicine.

[19]  M. T. Barcia,et al.  The influence of race on kidney graft survival. , 1999, Transplantation proceedings.

[20]  P. Austin,et al.  Effects of socioeconomic status on access to invasive cardiac procedures and on mortality after acute myocardial infarction. , 1999, The New England journal of medicine.

[21]  J. Curtis,et al.  Kidney transplantation: racial or socioeconomic disparities? , 1999, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[22]  Xin Qun Wang,et al.  Racial disparities in renal transplant outcomes. , 1999, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[23]  Bryan Cs Race and health care. , 1999 .

[24]  G. C. Alexander,et al.  Barriers to cadaveric renal transplantation among blacks, women, and the poor. , 1998, JAMA.

[25]  J. Neylan Racial differences in renal transplantation after immunosuppression with tacrolimus versus cyclosporine. FK506 Kidney Transplant Study Group. , 1998, Transplantation.

[26]  J. Neylan Immunosuppressive Therapy In High-risk Transplant Patients: Dose-dependent Efficacy Of Mycophenolate Mofetil In African-american Renal Allograft Recipients1 , 1997 .

[27]  Geiger Hj Race and health care--an American dilemma? , 1996 .

[28]  B D Kahan,et al.  Demographic factors influencing cyclosporine pharmacokinetic parameters in patients with uremia: Racial differences in bioavailability , 1992, Clinical pharmacology and therapeutics.

[29]  E. Meydrech,et al.  Racial differences in the survival of cadaveric renal allografts. Overriding effects of HLA matching and socioeconomic factors. , 1992, The New England journal of medicine.

[30]  B. Julian,et al.  IMPROVED SURVIVAL OF PRIMARY CADAVERIC RENAL ALLOGRAFTS IN BLACKS WITH QUADRUPLE IMMUNOSUPPRESSION1 , 1992, Transplantation.

[31]  G. Danovitch,et al.  The effect of race on access and outcome in transplantation. , 1991, The New England journal of medicine.

[32]  D. Altman,et al.  Bootstrap investigation of the stability of a Cox regression model. , 1989, Statistics in medicine.

[33]  Cecka Jm The OPTN/UNOS renal transplant registry. , 2005 .

[34]  J. Cecka,et al.  The OPTN/UNOS renal transplant registry. , 2004, Clinical transplants.

[35]  B. Pereira,et al.  Optimization of pre-ESRD care: the key to improved dialysis outcomes. , 2000, Kidney international.

[36]  D. Leehey,et al.  Improved graft survival after renal transplantation in the United States, 1988 to 1996. , 2000, The New England journal of medicine.

[37]  J. Cecka The UNOS Scientific Renal Transplant Registry--2000. , 2000, Clinical transplants.

[38]  Cecka Jm The UNOS Scientific Renal Transplant Registry. , 1999 .

[39]  J. Cecka The UNOS Scientific Renal Transplant Registry. , 1999, Clinical transplants.

[40]  J. Neylan Immunosuppressive therapy in high-risk transplant patients: dose-dependent efficacy of mycophenolate mofetil in African-American renal allograft recipients. U.S. Renal Transplant Mycophenolate Mofetil Study Group. , 1997, Transplantation.

[41]  D. Gjertson,et al.  Risk rate and long-term kidney transplant survival. , 1996, Clinical transplants.

[42]  A. Narva,et al.  Access of Native Americans to renal transplantation in Arizona and New Mexico. , 1996, Blood purification.

[43]  H. Geiger Race and health care--an American dilemma? , 1996, The New England journal of medicine.

[44]  R. Wilkins,et al.  How far is it to the nearest hospital? Calculating distances using the Statistics Canada Postal Code Conversion File. , 1993, Health reports.