Donor ethnicity influences outcomes following deceased-donor kidney transplantation in black recipients

Abstract

Although the majority of deceased-donor kidneys are donated after brain death, increased recovery of kidneys donated after cardiac death could reduce the organ shortage and is now a national priority. Racial disparities in donations after brain death have been well described for renal transplantation, but it is unknown whether similar disparities occur in donations after cardiac death. In this study, outcomes of adult deceased-donor renal transplant recipients included in the United Network for Organ Sharing database (1993 through 2006) were analyzed. Among black recipients of kidneys obtained after cardiac death, those who received kidneys from black donors had better long-term graft and patient survival than those who received kidneys from white donors. In addition, compared with standard-criteria kidneys from white donors after brain death, kidneys from black donors after cardiac death conferred a 70% reduction in the risk for graft loss (adjusted hazard ratio 0.30; 95% confidence interval 0.14 to 0.65; P = 0.002) and a 59% reduction in risk for death (adjusted hazard ratio 0.41; 95% confidence interval 0.2 to 0.87; P = 0.02) among black recipients. These findings suggest that kidneys obtained from black donors after cardiac death may afford the best long-term survival for black recipients.

Figure 1.

(A through F) Graft survival after SCD (A and B), ECD (C and D), and DCD (E and F) renal transplantation by donor and recipient ethnicity. Compared with SCD and ECD renal transplantation, outcomes after DCD renal transplantation seem to be less racially disparate. Each panel contains a graphic representation of the Kaplan-Meier survival function for DCGS.

Figure 2.

Graft survival for black recipients by donor ethnicity and subtype. The panel contains a graphic representation of the Kaplan-Meier survival function for DCGS. The 95% CI for 5-yr DCGS are presented in parentheses.

Figure 3.

Matched control analysis of graft and patient survival among black recipients. Each panel contains a graphic representation of the Kaplan-Meier survival function and a table of the adjusted hazard for DCGS (A) and patient survival (B). The 95% CI are presented in parentheses.