Influence of race on renal allograft survival in the pre- and postcyclosporine era

Abstract

In conclusion we find that white cadaveric recipients of renal allografts have clearly benefited from the use of CsA. Matching for the major histocompatibility antigens, especially HLA-B + DR, is also associated with improved allograft survival in whites. For black cadaveric recipients there was no significant improvement in allograft survival with the use of CsA nor with matching for HLA. In contrast, for recipients of LRD kidneys both races appear to benefit from the use of CsA over conventional therapy. Consequently, it is clear that with the excellent allograft survival in LRD black recipients that matching can have a significant beneficial effect. However, the differences in survival between the races of cadaveric recipients suggest that for blacks the use of CsA cannot overcome the inherent genetic or physiologic differences that may exist. These results suggest that blacks should be targeted for concentrated study, the benefits of which would be to increase our understanding of potential factors influencing allograft survival in a group that comprises an increasingly larger proportion of candidates on waiting lists throughout the United States. 1. Overall renal allograft survival in CsA-treated black recipients is significantly lower than in comparable white recipients. The major period of allograft loss is in the first 6 months after which the rates of allograft loss for blacks and whites are similar. 2. There was a 12% increase in allograft survival in CsA-treated cadaveric recipients compared to pre-CsA-treated recipients. Allograft survival in white recipients has increased 15% whereas for black recipients there was only a 5% improvement over the azathioprine-prednisone treatment group. 3. Overall, there was a significantly improved graft survival for primary transplants compared to retransplants. Renal allograft survival in black CsA-treated recipients of primary transplants was significantly lower than in comparable whites, whereas there was no significant difference in graft survival between black and white recipients of retransplants. 4. Allograft survival rates in black and white recipients of kidneys from living-related donors were not significantly different from each other in either the non-CsA or the CsA immunotherapy group. 5. Overall there was improved allograft survival with increased matching for HLA-DR or B + DR compared to a zero match in CsA-treated recipients. Significantly, the effect of matching for HLA-DR or B + DR was seen only in white recipients.(ABSTRACT TRUNCATED AT 400 WORDS)