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

Abstract

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.

Solid organ donor–recipient race‐matching: analysis of the United Network for Organ Sharing database

“…The significant decrease in patient and graft survival in African American recipients of race-matched pancreas transplants is particularly notable, as the 7.1% decrease in patient survival at 5 years (CI À2.4 to À11.7%, P-value 0.003) and 9.5% decrease in graft survival at 5 years (CI À3.4 to À15.6%, P-value < 0.001) were the greatest differences noted in any race category or organ system. Few prior studies have looked at the impact of racial factors on pancreas transplant outcomes [10], but as with most organ systems, organ scarcity, and annual transplant volume limit the utility of this finding to warrant consideration of race-matching in allocation of pancreas grafts. While the worsening of outcomes in race-matched African American recipients is surprising, it is not unprecedented.…”

Race does not predict pancreas graft failure after pancreas transplantation in the modern era

“…Rogers et al 9 and Luan et al 10 both reported that AA recipients had worse pancreatic graft survival than other racial recipients at 1, 3, and 5 years. Similarly, Danovitch et al 20 revealed that AA recipients experienced higher rate of pancreatic graft failure than Caucasian recipients.…”

“…in 1966, there have been numerous advances in the surgical technique and immunosuppressive regimens, allowing for better pancreatic graft and patient survival 7 . Despite these innovations in PTx, racial differences are known to exist that affect the outcomes, as not all racial recipients or donors have the same survival benefit 4,8–12 …”

“…Several studies suggest that AA recipients experience significantly worse outcomes than non-AA recipients after PTx. [9][10][11] Using national data, Luan et al 10 reported that AA patients had a 47% higher risk for pancreatic graft failure and were twice more likely to lose the pancreatic graft owing to rejection than the non-AA counterparts. In contrast, some studies showed that AA recipients had similar survival rates as other races in the era of modern immunosuppression and transplantation.…”

Surgical Morbidity of Simultaneous Kidney and Pancreas Transplantation: A Single-Centre Experience in the Tacrolimus Era

“…In this series, primary thrombosis accounted for 12 of 28 (50%) death-censored gra failures and was responsible for 11/14 pancreatic gras (78.6%) lost within a month of transplantation. Large series have documented thrombosis to be responsible for the majority of technical failures and early gra loss [4,23]. Factors that have been shown to predispose to gra thrombosis include recipient obesity, preservation time, and nontraumatic causes of donor death [4,24].…”