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Kidney Week

Abstract: PO2497

Impact of Ethnicity Matching on Kidney Transplant Outcomes Among African Americans: A Mate Kidney Analysis

Session Information

Category: Transplantation

  • 1902 Transplantation: Clinical

Authors

  • Sureshkumar, Kalathil K., Allegheny General Hospital, Pittsburgh, Pennsylvania, United States
  • Chopra, Bhavna, Allegheny General Hospital, Pittsburgh, Pennsylvania, United States
  • McGill, Rita L., University of Chicago, Chicago, Illinois, United States
Background

Transplantation of kidneys from African American (AA) donors is associated with poorer outcomes compared to transplants from white Americans. Unmeasured variables such as APOL1 renal risk variants and sickle cell trait could contribute to the heightened risk. We used a mate kidney model to test the hypothesis that enhanced genetic risks associated with AA donor kidneys could be counterbalanced by favorable immunologic matching when AA donor kidneys are transplanted into AA recipients.

Methods

We identified AA deceased donors in OPTN/UNOS database from 2000 to September 2019 in which both kidneys were transplanted into first-time kidney-only recipients, and both recipients received induction therapy followed by tacrolimus/mycophenolic acid maintenance. Marginal models for hazards of graft failure, death censored graft failure (DCGF) and death were constructed, with adjustments for recipient and transplant variables. Outcomes of AA, Hispanic, and Asian recipients were compared, using white American recipients as reference. Results were compared to a parallel analysis of 41,886 recipients of white American donor kidneys.

Results

Median follow up of the study was 3.3 (IQR 1.1-6.5) years among 8194 paired recipients of AA donor kidneys. Despite donor ethnicity matching, DCGF was higher but mortality lower among AA recipients. Graft failure did not differ. Hispanic and Asian recipients had lower hazards of most unfavorable outcomes (table 1).In the parallel analysis, DCGF was again inferior for AA recipient of white American donor kidney (HR 1.37, 95% CI 1.28-1.47, p<0.001).

Conclusion

Our data indicate an increased risk of DCGF in AA recipients of AA donor kidneys, despite the potential benefits of favorable immunologic matching and does not support an ethnicity-matching strategy to improve outcomes and reduce disparities. Our observations suggest that other recipient factors predominantly influence graft outcomes. Improved outcomes in Hispanic and Asian patients merit further study.

Table 1. Adjusted outcomes for paired recipients of AA donor kidneys with white American recipients as reference
Recipient ethnicityAfrican AmericanHispanicAsian
 HR (95% CI)PHR (95% CI)PHR (95% CI)P
Graft failure1.07
(0.97-1.19)
0.20.72
(0.61-0.84)
<0.0010.75
(0.59-0.95)
0.02
Death-censored graft failure1.31
(1.14-1.50)
<0.0010.80
(0.65-0.99)
0.040.79
(0.57-1.10)
0.2
Death0.87
(0.77-0.98)
0.020.57
(0.47-0.69)
<0.0010.68
(0.52-0.90
0.006

Funding

  • Private Foundation Support