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Kidney Week

Abstract: FR-PO1193

Association of Race and Risk of Graft Loss Among Kidney Transplant Recipients in the Military Health System

Session Information

Category: Transplantation

  • 1902 Transplantation: Clinical

Authors

  • Forman, Crystal, San Antonio Uniformed Services Health Education Consortium, San Antonio, Texas, United States
  • Yuan, Christina M., Walter Reed National Military Medical Center, Bethesda, Maryland, United States
  • Jindal, Rahul M., Uniformed Services University of Health Sciences, Bethesda, Maryland, United States
  • Agodoa, Lawrence, The National Institutes of Health, NIDDK, Bethesda, Maryland, United States
  • Abbott, Kevin C., The National Institutes of Health, NIDDK, Bethesda, Maryland, United States
  • Nee, Robert, Walter Reed National Military Medical Center, Bethesda, Maryland, United States
Background


Racial disparities in transplant outcomes are well documented, attributed to both immunologic and non-immunologic risk factors that include social determinants of health. We assessed differences in graft survival between Black and White kidney transplant recipients in the Military Health System (MHS), a model of universal health care and free lifelong access to immunosuppressive medications.

Methods

Using the United States Renal Data System database, we identified 449 (0.16%) MHS patients first transplanted from January 1, 1995 to January 1, 2018, out of a total of 276,564 patients in the US. We examined the time to first graft loss using Kaplan-Meier and Cox regression analyses, adjusted for demographic, clinical and socioeconomic factors (health insurance, employment, education level, ZIP code-level median household income).

Results

In the MHS, 43% of Black recipients experienced graft loss compared with 35% of Whites (p=0.11). Death-censored graft loss for Blacks was 28% vs. 19% in Whites (p=0.05). MHS Blacks had an adjusted hazard ratio (aHR) of 0.88 (95% CI 0.39-1.98, p=0.75) for overall graft loss compared to their White counterparts. In the wider non-MHS cohort, Black recipients had an increased risk of overall graft loss compared to Whites (aHR 1.11, 95% CI 1.08-1.14, p<0.001). Estimated graft survival was similar between MHS Blacks and non-MHS Whites (Figure).

Conclusion

In the MHS, Black transplant recipients did not have a statistically significant higher risk of overall graft loss compared to their White counterparts, a finding that differs from the broader transplant population. {The views expressed in this abstract are those of the authors and do not reflect the official policy of the National Institutes of Health, the Department of Army/Navy/Air Force, Department of Defense, or U.S. Government}.

First graft loss in kidney transplant recipients, stratified by racial/MHS groups