Effect of Ethnicity on Outcome of Simultaneous Pancreas and Kidney Transplantation

Rogers, Jeffrey; Baliga, Prabhakar K.; Chavin, Kenneth D.; Lin, Angello; Emovon, Osemwegie E.; Afzal, Fuad; Baillie, G. Mark; Ashcraft, Elizabeth E.; Rajagopalan, P. R.

doi:10.1046/j.1600-6143.2003.00208.x

Cited by 17 publications

(25 citation statements)

References 37 publications

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“…Ethnic disparities in transplant‐related outcomes have been reported for a number of variables, e.g., graft and patient survival, rejection, metabolic complications, and infections 17–30. Racial differences in human leukocyte antigen phenotypes and in human leukocyte antigen matching are one proposed basis for these observations 18, 22, 24, 29.…”

Section: Discussionmentioning

confidence: 99%

Who among cytomegalovirus-seropositive liver transplant recipients is at risk for cytomegalovirus infection?

Singh¹,

Wannstedt

Keyes

et al. 2005

Liver Transpl

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A vast majority of the transplant recipients are cytomegalovirus (CMV)-seropositive (R؉). We sought to assess variables predictive of CMV infection, specifically in R؉ liver transplant recipients. Study patients comprised 182 consecutive liver transplant recipients who survived at least 14 days after transplantation. Surveillance testing was used to detect CMV infection. Pre-emptive therapy was employed for the prevention of CMV disease, however, no antiviral prophylaxis was used for CMV infection. CMV infection developed in 32.5% (38 of 117) of R؉ patients, 84.6% (33 of 39) of R؊/D؉, and 3.8% (1 of 26) of R؊/D؊ patients. In R؉ patients, Hispanic race (21.6% vs. 7.8%, P ‫؍‬ 0.06), donor CMV seropositivity (73.7% vs. 45.6%, P ‫؍‬ 0.005), and hepatocellular carcinoma (23.7% vs. 6.3%, P ‫؍‬ 0.05) correlated with a higher risk of CMV infection. In a multivariate model, Hispanic race (OR: 3.5, 95% CI: 1.03-11.6, P ‫؍‬ 0.045), donor CMV serostatus (OR: 4.0, 95% CI: 1.6-10.2, P ‫؍‬ 0.003) and hepatocellular carcinoma (OR: 5.8, 95% CI: 1.6-20.5, P ‫؍‬ 0.006) were all significant independent predictors of CMV infection. The aforementioned variables did not portend a higher risk of CMV infection in R؊/D؉ patients; donor CMV seropositivity overwhelmed all other risk factors in R؊ patients (P < 0.00001). In conclusion, CMV-seropositive liver transplant recipients at risk for CMV infection can be identified based on readily assessable variables. Preventive strategies may be selectively targeted toward these patients. (Liver Transpl 2005;11:700-704.)

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Section: Discussionmentioning

confidence: 99%

Who among cytomegalovirus-seropositive liver transplant recipients is at risk for cytomegalovirus infection?

Singh¹,

Wannstedt

Keyes

et al. 2005

Liver Transpl

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“…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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“…However, relatively little is known about differences in posttransplant outcomes between patients of specific racial and ethnic populations (4–6). Nevertheless, it is widely believed that graft and patient survivals for minority transplant recipients are inferior to those observed for whites.…”

Section: Introductionmentioning

confidence: 99%

Access and Outcomes Among Minority Transplant Patients, 1999-2008, with a Focus on Determinants of Kidney Graft Survival

Fan

Ashby

Fuller

et al. 2010

American Journal of Transplantation

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Coincident with an increasing national interest in equitable health care, a number of studies have described disparities in access to solid organ transplantation for minority patients. In contrast, relatively little is known about differences in posttransplant outcomes between patients of specific racial and ethnic populations. In this paper, we review trends in access to solid organ transplantation and posttransplant outcomes by organ type, race and ethnicity. In addition, we present an analysis of categories of factors that contribute to the racial/ethnic variation seen in kidney transplant outcomes. Disparities in minority access to transplantation among wait-listed candidates are improving, but persist for those awaiting kidney, simultaneous kidney and pancreas and intestine transplantation. In general, graft and patient survival among recipients of solid organ transplants is highest for Asians and Hispanic/Latinos, intermediate for whites and lowest for African Americans. Although much of the difference in outcomes between racial/ethnic groups can be accounted for by adjusting for patient characteristics, important observed differences remain. Age and duration of pretransplant dialysis exposure emerge as the most important determinants of survival in an investigation of the relative impact of center-related versus patient-related variables on kidney graft outcomes.

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Effect of Ethnicity on Outcome of Simultaneous Pancreas and Kidney Transplantation

Cited by 17 publications

References 37 publications

Who among cytomegalovirus-seropositive liver transplant recipients is at risk for cytomegalovirus infection?

Who among cytomegalovirus-seropositive liver transplant recipients is at risk for cytomegalovirus infection?

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

Access and Outcomes Among Minority Transplant Patients, 1999-2008, with a Focus on Determinants of Kidney Graft Survival

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