Abstract: FR-PO1036
Impact of Donor Ethnicity on Long-Term Kidney Transplant Outcomes
Session Information
- Transplantation: Donor-Candidate Assessment and Predictors of Outcome
November 03, 2017 | Location: Hall H, Morial Convention Center
Abstract Time: 10:00 AM - 10:00 AM
Category: Transplantation
- 1702 Transplantation: Clinical and Translational
Authors
- Chopra, Bhavna, Allegheny General Hospital, Pittsburgh, Pennsylvania, United States
- Sureshkumar, Kalathil K., Allegheny General Hospital, Pittsburgh, Pennsylvania, United States
Background
African American (AA) ethnicity increases the risk for developing chronic kidney disease (CKD). There is limited data on graft outcomes based on donor ethnicity. Donor ethicity is a variable in the kidney donor profile index (KDPI) designed to aid in organ allocation and in predicting long-term transplant outcomes. We aimed to evaluate long-term kidney transplant outcomes based on donor ethnicity under different KDPI groups.
Methods
Using the OPTN/UNOS database, adult deceased donor kidney (DDK) transplant recipients from 2000 to 2015 who received induction therapy and were discharged on calcineurin inhibitor/ mycophenolate mofetil-based maintenance were identified. Patients were further divided into 4 KDPI categories (0-20%,21-50%,51-85% and >85%). Long term graft and patient outcomes were compared for recipients of AA vs. non-AA donor kidneys under each KDPI group in a multivariate Cox model.
Results
There were 59,648 participants in the study cohort with a median follow up of 48 months. Adjusted graft and patient outcomes among recipients of AA vs.non-AA donor kidneys by KDPI groups are shown in Table 1 and Figure 1. Overall and death-censored graft failure risks were higher for recipeints of AA donor kidneys among higher KDPI (51-85% and >85%) groups but similar among lower KDPI (0-20 and 21-50%) groups. Patient survivals were similar.
Conclusion
Our study showed inferior graft outcomes among recipients of AA donor kidneys in higher KDPI groups despite ethnicity being a variable in deriving KDPI. One could speculate that higher prevalence of risk factors for CKD progression such as APOL1 and sickle cell trait gene mutations among other factors in AA population as contributing to inferior graft outcomes. Prospective studies are needed to further elucidate these findings.
| Table 1 | KDPI 0-20% AA donor; n=560 Non-AA donor; n=14690 | KDPI 21-50% AA donor; n=2807 Non-AA donor; n=16548 | KDPI 51-85% AA donor; n=2774 Non-AA donor; n=16638 | KDPI >85% AA donor; n=1670 Non-AA donor; n=3961 | ||||
| HR (95% CI) | p | HR (95% CI) | p | HR (95% CI) | p | HR (95% CI) | p | |
| Adjusted overall graft failure risk | 1.18 (0.99-1.41) | 0.61 | 1.05 (0.95-1.15) | 0.32 | 1.12(1.02-1.20) | 0.009 | 1.12 (1.04-1.24) | 0.03 |
| Adjusted death-censored graft failure risk | 1.19 (0.93-1.50) | 0.16 | 1.11 (0.97-1.25) | 0.11 | 1.12 (1.01-1.25) | 0.03 | 1.33 (1.16-1.51) | <0.001 |
| Adjusted patient death risk | 1.22 (0.99-1.50) | 0.07 | 1.02 (0.91-1.15) | 0.70 | 1.09 (0.99-1.20) | 0.09 | 1.03 (0.91-1.16) | 0.63 |