COMPARISON OF RISK FACTORS FOR RENAL GRAFT FAILURE IN CAUCASIANS AND AFRICAN-AMERICANS

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494 Although the negative effect of African-American race on renal graft outcome is well known, the reasons for this effect remain speculative. The purpose of this study is to compare risk factors for renal graft failure in Caucasian (C) and African-American (AA) recipients of kidney transplants. Between 1/3/90 and 9/26/98, 546 renal transplants were performed at our center. Of these, 309 (56%) were C and 237 (43%) were AA. Fewer living-donor transplants were performed in AA compared to C (30% vs 46%, P=0.001). C and AA were comparable with respect to: donor demographics (age, gender, cold ischemic time, cadaver donor cause of death) and recipient demographics (age, gender, % PRA, body mass index). The following characteristics differed (C vs AA): Pre-dialysis (21% vs 6%, P=0.04), median duration of pre-transplant dialysis (533 vs 838 days, P<0.0005), antibody induction (29% vs 57%, P<0.0005), % diabetics (27% vs 20%, P<0.0005), HLA mismatch (2.4±1.7 vs 3.2±1.6, P<0.0005). Only biopsy-proven acute rejection (AR) episodes were considered. Delayed graft function (DGF) was defined as the need for dialysis ≤7 days post-transplant. DGF was more frequent in AA (40% vs 20%, P<0.0005). AR was also more frequent in AA (43% vs 30%, P=0.002). For cadaver transplants, 1 and 5 year graft survival rates were 86% and 75% in C compared to 76% and 55% in AA (P=0.0002). For living-donor transplants, 1 and 5 year graft survival rates were 93% and 86% in C compared to 87% and 75% in AA (P=0.1). Risk factors for renal graft failure are summarized below by descending order of significance for C (Cox regression analysis, RR=relative risk factor): (Table)TableIn conclusion, risk factors for renal graft failure common to C and AA were (1) AR, and (2) cadaver donor. Risk factors observed in C but not AA included (1) DGF, (2) PRA>10%, (3) antibody-free induction and (4) diabetes.

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