Overall Graft Loss Versus Death-Censored Graft Loss

Taber, David J.; Gebregziabher, Mulugeta; Payne, Elizabeth H.; Srinivas, Titte R.; Baliga, Prabhakar K.; Egede, Leonard E.

doi:10.1097/tp.0000000000001119

Cited by 27 publications

(13 citation statements)

References 41 publications

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“…Our results are consistent with prior findings that link the risk of graft rejection or failure to Black race, male gender, age, hypertension, and glomerulonephritis [16,[19][20][21][22]. A retrospective, cross-sectional study that used HCUP-NIS 1995-2005 discharge data found that independent predictors of complications following renal transplant included older age, male gender, and CCI ≥ 1 [22]. Our findings are consistent with the results of previous studies that highlight racial disparities in renal transplant outcomes.…”

Section: Discussionsupporting

confidence: 92%

“…Our findings are consistent with the results of previous studies that highlight racial disparities in renal transplant outcomes. For example, in their longitudinal, cohort study of 4,918 renal transplant recipients (33% were non-Hispanic Black recipients), Taber et al [22] found that non-Hispanic Blacks were significantly more likely to experience graft loss; others have noted that Blacks have worse outcomes in sepsis, likely due to a multitude of factors [23,24]. How these factors intersect in renal transplant patients with sepsis is not understood and warrants further investigation.…”

Section: Discussionmentioning

confidence: 99%

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Risk factors for complications and graft failure in kidney transplant patients with sepsis

Syu

Lin

et al. 2018

Bosn J of Basic Med Sci

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Immunosuppressive therapies decreased the incidence of acute kidney rejection after kidney transplantation, but also increased the risk of infections and sepsis. This study aimed to identify the risk factors associated with complications and/or graft failure in kidney transplant patients with sepsis. A total of 14,658 kidney transplant patients with sepsis, identified in the National Inpatient Sample (NIS) database (data from 2005–2014), were included in the study and classified into three groups: patients without complications or graft failure/dialysis (Group 1), patients with complications only (Group 2), and patients with complications and graft failure/dialysis (Group 3). Multinomial logistic regression analyses were conducted to evaluate factors associated with kidney transplant recipients. Multivariate analysis showed that, compared to Group 1, patients from Group 2 or Group 3 were more likely to be Black and to have cytomegalovirus infection, coagulopathy, and glomerulonephritis (p ≤ 0.041). Also, Group 2 was more likely to have herpes simplex virus infection, and Group 3 was more likely to have hepatitis C infection and peripheral vascular disorders, compared to Group 1 (p ≤ 0.002). In addition, patients from Group 3 were more likely to be Black and to have hepatitis C infection, peripheral vascular disorders, coagulopathy, and hypertension compared to Group 2 (p ≤ 0.039). Age and female gender were associated with lower odds of complications after kidney transplantation regardless of graft rejection/dialysis (p ≤ 0.049). Hyperlipidemia and diabetes decreased the chance of complications and graft failure/dialysis after kidney transplant (p < 0.001). In conclusion, the study highlights that black race, male gender, and specific comorbidities can increase the risk of complications and graft failure in kidney transplant patients with sepsis.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Risk factors for complications and graft failure in kidney transplant patients with sepsis

Syu

Lin

et al. 2018

Bosn J of Basic Med Sci

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“…We validated data elements by comparing them between the two databases for accuracy and were able to include the largest number of covariates ever reported in a transplant racial disparities analysis. 40 In addition, retrospectively accurately assessing control of CVD risk factors is a difficult endeavor, and using means during the entire follow up may not truly capture the time dependency of this exposure. However, using the means does allow for a more straightforward analysis and presentation of the data.…”

Section: Discussionmentioning

confidence: 99%

Impact of Cardiovascular Risk Factors on Graft Outcome Disparities in Black Kidney Transplant Recipients

et al. 2016

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Although outcome inequalities for non-Hispanic Black (NHB) kidney transplant recipients are well documented, there is paucity in data assessing the impact of cardiovascular disease (CVD) risk factors on this disparity in kidney transplantation. This was a longitudinal study of a national cohort of veteran kidney recipients transplanted between Jan 2001 and Dec 2007. Data included baseline characteristics acquired through the USRDS linked to detailed clinical follow up information acquired through the VA electronic health records. Analyses were conducted using sequential multivariable modeling (Cox regression), incorporating blocks of variables into iterative nested models; 3,139 patients were included (2,095 NHW [66.7%] and 1,044 NHBs [33.3%]). NHBs had a higher prevalence of hypertension (100% vs. 99%, p<0.01) and post-transplant diabetes (59% vs. 53%, p<0.01) with reduced control of hypertension (BP <140/90, 60% vs. 69% p<0.01), diabetes (A1c <7%, 35% vs. 47%, p<0.01) and LDL (<100 mg/dL, 55% vs. 61%, p<0.01). Adherence to medications used to manage CVD risk was significantly lower in NHBs. In the fully adjusted models, the independent risk of graft loss in NHBs was substantially reduced (unadjusted HR 2.00 vs. adjusted HR 1.49). CVD risk factors and control reduced the influence of NHB race by 9–18%. Similar trends were noted for mortality and estimates were robust across in sensitivity analyses. These results demonstrate that NHB kidney transplant recipients have significantly higher rates of CVD risk factors and reduced CVD risk control. These issues are likely partly related to medication non-adherence and meaningfully contribute to racial disparities for graft outcomes.

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“…17–20 There have been numerous studies elucidating the explanatory factors associated with this disparity, including biologic differences (immunologic risk and gene polymorphisms) and socioeconomic disadvantages. 21–26 AAs are substantially more likely to express the CYP 3A5 *1 polymorphism, which is linked to increased tacrolimus clearance and variability.…”

Section: Introductionmentioning

confidence: 99%

Tacrolimus Trough Concentration Variability and Disparities in African American Kidney Transplantation

Taber

Fleming

et al. 2017

Transplantation

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Background Low tacrolimus concentrations have been associated with higher risk of acute rejection, particularly within African-American (AA) kidney transplant recipients; little is known about intrapatient tacrolimus variabilities impact on racial disparities. Methods Ten year, single-center, longitudinal cohort study of kidney recipients. Intrapatient tacrolimus variability was assessed using the coefficient of variation (CV) measured between 1 month posttransplant and the clinical event, with a comparable period assessed in those without events. Pediatrics, nontacrolimus/mycophenolate regimens and nonrenal transplants were excluded. Multivariable Cox regression models were used to analyze data. Results 1411 recipients were included (54.4% AA) with 39 521 concentrations utilized to assess intrapatient tacrolimus CV. Overall, intrapatient tacrolimus CV was higher in AAs vs non-AAs (39.9±19.8 % vs. 34.8±15.8% p<0.001). Tacrolimus variability was a significant risk factor for deleterious clinical outcomes. A 10% increase in tacrolimus CV augmented the risk of acute rejection by 20% (aHR 1.20, 1.13–1.28; p<0.001) and the risk of graft loss by 30% (aHR 1.30, 1.23–1.37; p<0.001), with significant effect modification by race for acute rejection, but not graft loss. High tacrolimus variability (CV >40%) was a significant explanatory variable for disparities in AAs; the crude relative risk of acute rejection in AAs was reduced by 46% when including tacrolimus variability in modeling and reduced by 40% for graft loss. Conclusions These data demonstrate that intrapatient tacrolimus variability is strongly associated with acute rejection in AAs and graft loss in all patients. Tacrolimus variability is a significant explanatory variable for disparities in AA recipients.

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Overall Graft Loss Versus Death-Censored Graft Loss

Cited by 27 publications

References 41 publications

Risk factors for complications and graft failure in kidney transplant patients with sepsis

Risk factors for complications and graft failure in kidney transplant patients with sepsis

Impact of Cardiovascular Risk Factors on Graft Outcome Disparities in Black Kidney Transplant Recipients

Tacrolimus Trough Concentration Variability and Disparities in African American Kidney Transplantation

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