Outcome predictors in African‐American deceased‐donor renal allograft recipients

Abstract

The relative importance of donor and recipient risk factors in predicting outcomes in African-American (AA) renal allograft recipients receiving contemporary immunosuppression, including early steroid withdrawal, has not been previously examined. We assessed the impact of 21 risk factors on five primary outcomes in 132 deceased-donor AA renal allograft recipients transplanted from July 2001 to August 2006 with follow-up 6-67 (mean 35 +/- 17) months by univariate and multivariate analysis. Thymoglobulin or basiliximab was given for induction, and mycophenolate mofetil with either tacrolimus or sirolimus (SRL) +/- prednisone for maintenance. Non-compliance accounted for 26% of graft loss (GL) and 19% of acute rejection (AR) episodes, and was more prevalent in patients who were HCV+ and those on prednisone. Delayed graft function remained a significant predictor of GL, but not via increased AR, and donor ethnicity emerged as an important predictor of patient death. De novo use of SRL resulted in increased AR, and only increased recipient age significantly predicted new-onset diabetes mellitus. Our preliminary results suggest the need for improvements in patient education, pre-transplant psychosocial assessment, and late post-transplant psychosocial support and can be utilized to help guide donor/recipient selection and tailor immunosuppressive management to optimize outcomes in this challenging group of patients.

Renal allograft rejection, lymphocyte infiltration, and de novo donor-specific antibodies in a novel model of non-adherence to immunosuppressive therapy

“…In our model, de novo DSA were detected in rat serum under conditions mimicking non-adherence to therapy. This corresponds to data from studies of renal transplant patients [ 3 , 10 , 11 ]. Antibodies were shown to be donor-specific, since binding of recipient Lewis rat splenocytes did not occur.…”

Long‐term outcomes in African American kidney transplant recipients under contemporary immunosuppression: a four‐yr analysis of the Mycophenolic acid Observational REnal transplant (MORE) study

“…In our population, the risk of graft loss remained higher in AA patients even after adjustment for donor type and DGF. Non‐adherence and comorbid conditions such as cardiovascular disease and diabetes in AA recipients also contribute, but were not recorded in the MORE study.…”

609 Steroid Avoidance in Pediatric Heart Transplantation Results in Excellent Graft Survival

“…Why additional immunosuppression did not result in improved graft survival is unclear. We speculate that medication nonadherence may have been more common in the MS group because of the many side effects of corticosteroids, and any benefit of the additional immunosuppression could have been countered by a higher likelihood of nonadherence (17). However, we were unable to analyze nonadherence patterns with the available data.…”