A Comparison of Long-Term Survivals of Simultaneous Pancreas–Kidney Transplant between African American and Caucasian Recipients with Basiliximab Induction Therapy

Zhang, R.; Florman, Sandy; Devidoss, Sharmila; Zarifian, April; Yau, C. Lillian; Paramesh, Anil; Killackey, Mary; Alper, Brent; Fonseca, V.; Slakey, D.

doi:10.1111/j.1600-6143.2007.01857.x

Cited by 14 publications

(15 citation statements)

References 21 publications

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“…When compared with other solid organ transplants, pancreas transplantation is still burdened with significant rates of early graft loss [12–14]. Because of the high vulnerability of the pancreas, a meticulous surgical technique is essential to achieve a favorable early post‐transplant outcome.…”

Section: Discussionmentioning

confidence: 99%

A prospective randomized multicenter trial comparing histidine-tryptophane-ketoglutarate versus University of Wisconsin perfusion solution in clinical pancreas transplantation

Schneeberger

Biebl

Steurer

et al. 2008

Transplant International

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Summary We aimed to evaluate early pancreas transplant graft function after histidine–tryptophan–ketoglutarate (HTK) versus University of Wisconsin (UW) perfusion. Prospective randomized multicenter study including 68 pancreas transplantations stratified according to preservation fluid used (27 HTK vs. 41 UW). Primary endpoint was pancreas graft survival at 6 months. Serum α‐amylase, lipase, C‐peptide, HbA1C and exogenous insulin requirement were compared at several time points. Mean pancreas cold ischemia time was 10.8 ± 3.7 (HTK) vs. 11.8 ± 3.4 h (UW) (P = 0.247). Simultaneous pancreas–kidney transplantation was performed in 95.6% of the patients, pancreas transplantation alone in 2.9%, and pancreas after kidney transplantation in 1.5%. Six months graft survival was 85.2% (HTK) vs. 90.2% (UW) (P = 0.703). Serum amylase and lipase values did not differ between both the groups during the observation period. C‐peptide levels were elevated in both the groups without significant differences at each time point. Higher exogenous insulin requirement early after transplantation in the UW group had resolved at 3 months. Six month patient survival was 96.3% (HTK) vs. 100% (UW) (P = 0.397). With a mean cold ischemia time of 10 h in this study, HTK and UW solutions appear to be equally suitable for perfusion and organ preservation in clinical pancreas transplantation.

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Section: Discussionmentioning

confidence: 99%

A prospective randomized multicenter trial comparing histidine-tryptophane-ketoglutarate versus University of Wisconsin perfusion solution in clinical pancreas transplantation

Schneeberger

Biebl

Steurer

et al. 2008

Transplant International

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“…However, the reduction in acute rejection has not lead to the elimination of gap in the outcome between AA and non-AA kidney transplant patients (37). (27). In studies comparing the outcome of SPK versus kidney transplant alone using large registry data, AA patients had higher risk for kidney graft failure compared to non-AA patients (21,39 …”

Section: Discussionmentioning

confidence: 99%

“…AA kidney transplant patients have higher risk for kidney graft loss and require increased levels of immunosuppression (21)(22)(23)(24)(25). However, literature on such racial disparity regarding pancreas transplant outcome in the setting of SPK transplantation remains limited and controversial as most reports were generated from small numbers of AA SPK transplant patients involved in clinical trials or in single-center studies (26)(27)(28). …”

Section: Simultaneous Pancreas and Kidney (Spk) Transplantation Is Thmentioning

confidence: 99%

Influence of Recipient Race on the Outcome of Simultaneous Pancreas and Kidney Transplantation

Luan

Kommareddi

Cibrik

et al. 2010

American Journal of Transplantation

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Racial differences on the outcome of simultaneous pancreas and kidney (SPK) transplantation have not been well studied. We compared mortality and graft survival of African Americans (AA) recipients to other racial/ethnic groups (non-AA) using the national data. We studied a total of 6585 adult SPK transplants performed in the United States between January 1, 2000 and December 31, 2007. We performed multivariate logistic regression analyses to determine risk factors associated with early graft failure and immune-mediated late graft loss. We used conditional Kaplan-Meier survival and multivariate Cox regression analyses to estimate late death-censored kidney and pancreas graft failure and death between the groups. Although there was no racial disparity in the first 90 days, AA patients had 38% and 47% higher risk for late deathcensored kidney and pancreas graft failure, respectively (p = 0.006 and 0.001). AA patients were twice more likely to lose the kidney and pancreas graft due to rejection (OR 2.31 and 1.86, p = 0.002 and 0.008, respectively). Bladder pancreas drainage was associated with inferior patient survival (HR 1.42, 95% CI 1.15, 1.75, p = 0.001). In the era of modern immunosuppresion, AA SPK transplant patients continue to have inferior graft outcome. Additional studies to explore the mechanisms of such racial disparity are warranted.

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“…A recent analysis based on United States Renal Data System from 2000 to 2005 indicated that both patient and graft survival were similar in AA and Caucasian patients using either thymoglobulin or IL‐2 receptor antibody induction [24]. As reported previously, our center’s experience suggested that T‐cell depleting antibody induction might no longer be necessary in the era of potent maintenance of tacrolimus, mycophenolate acid and steroids [25,26]. Non‐T‐cell depleting antibody basiliximab induction was used for our high‐risk patients, including in this study.…”

Section: Discussionmentioning

confidence: 63%

Long-term outcome of highly sensitized African American patients transplanted with deceased donor kidneys

Ren¹,

Paramesh²,

Yau³

et al. 2010

Transplant International

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Summary Undertaking transplantation in highly sensitized African American (AA) patients as transplant recipients represents a unique challenge. We retrospectively compared the outcomes of AA with non‐African American (NAA) patients who had panel reactive antibody >80% and received deceased donor (DD) kidneys by virtual crossmatch. Immunosuppressive regimen included basiliximab induction and tacrolimus, mycophenolate acid and steroids maintenance. Among 835 consecutive transplants from 1998 to 2007, 142 (17%) were sensitized patients including 89 (16.6%) AA and 53 (17.7%) NAA patients. The AA group had similar 5‐year incidence of acute rejection as NAA group (21.4% vs. 26.4%, P = 0.25). Kaplan–Meier estimated graft survival at 1, 3 and 5 years were 91%, 85% and 82% in AA group, and 94%, 79% and 71% in NAA group (P = 0.08). The death‐censored graft survival at 1, 3, and 5 years were 93%, 86% and 84% in AA group, and 96%, 83% and 78% in NAA group (P = 0.11). The 1, 3, and 5 years patient survivals were 93%, 88% and 85% in AA group, and 96%, 96% and 94% in NAA group (P = 0.17). Highly sensitized AA patients could be transplanted with DD kidneys at a similar rate as NAA patients, and they may not have a higher incidence of rejection or an inferior graft survival than NAA patients.

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A Comparison of Long-Term Survivals of Simultaneous Pancreas–Kidney Transplant between African American and Caucasian Recipients with Basiliximab Induction Therapy

Cited by 14 publications

References 21 publications

A prospective randomized multicenter trial comparing histidine-tryptophane-ketoglutarate versus University of Wisconsin perfusion solution in clinical pancreas transplantation

A prospective randomized multicenter trial comparing histidine-tryptophane-ketoglutarate versus University of Wisconsin perfusion solution in clinical pancreas transplantation

Influence of Recipient Race on the Outcome of Simultaneous Pancreas and Kidney Transplantation

Long-term outcome of highly sensitized African American patients transplanted with deceased donor kidneys

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