Race effects

Abstract

1. One-year graft survival rates for cyclosporine-treated first cadaver donor transplants were 80% for 14,911 White recipients, 74% for 3,845 Blacks, 84% for 951 Asians, and 81% for 1,319 Hispanics reported to the UCLA Renal Transplant Registry between January 1984 and December 1991. 2. One-year graft survival rates for similar transplants reported to the UNOS Scientific Renal Transplant Registry between October 1987 and December 1991 were 83% for 10,518 Whites, 79% for 3,655 Blacks, 82% for 429 Asians, and 84% for 1,277 Hispanic recipients. 3. Transplant half-lives calculated after 6 months were 10 years for Asian recipients, 9 years for Whites, 6 years for Hispanics, and 4 years for Black recipients (UCLA Registry). 4. Patient survival was 93% and 85% at 1 and 3 years, respectively, for both Black and White recipients of first cadaver transplants. Patient survival was 94% and 89% at 1 and 3 years, respectively, for Asian and Hispanic recipients (UCLA Registry). 5. Asian recipients had significantly better graft survival than Whites (4% through 3 years, p less than 0.05). This high survival was not affected by donor race, although HLA-matching was remarkably better in Asian-to-Asian combinations than White-to-Asian, nor by whether the transplant was performed in the United States or Canada, or at other international centers (UCLA Registry). 6. The poor graft survival of Black recipients at 1 and 3 years was strongly influenced by age-dependent factors. Black recipients of either sex aged 16-30 had the poorest graft survival rates (UCLA Registry). 7. Blacks were sensitized more often than Whites (17 vs 15%, p less than 0.01). Even moderate sensitization reduced 1-year graft survival from 76% to 71% (p less than 0.05) in Blacks whereas there was no effect in recipients of other races. By contrast, broad sensitization did not affect 1-year graft survival in Hispanic recipients (UCLA Registry). 8. Blacks received more poorly HLA-matched transplants than recipients of other races. Only 2% received HLA-A,B-matched kidneys and 29% received completely HLA-A,B-mismatched transplants (p less than 0.01). More than 30% received transplants mismatched at 2 HLA-DR antigens (p less than 0.01) (UCLA Registry). 9. Although there were clear racial differences in the original diseases leading to end-stage renal disease, the recipient's race was a stronger predictor of graft outcome than disease (UCLA Registry).(ABSTRACT TRUNCATED AT 400 WORDS)