Racial Disparity in Renal Transplantation

Smith, Alison; John, Mira; Dortonne, Isabelle; Paramesh, Anil; Killackey, Mary; Jaffe, Bernard M.; Buell, Joseph F.

doi:10.1097/sla.0000000000001385

Cited by 11 publications

(6 citation statements)

References 16 publications

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“…A 2013 retrospective report by Hussain and colleagues showed that, regardless of induction (alemtuzumab or ATG), graft survival rates did not differ in African American deceased-donor kidney transplant recipients [ 43 ]. Another study has shown that alemtuzumab induction eliminates the posttransplant survival disparity between White and African American recipients by improving graft survival in all recipients [ 44 ].…”

Section: Discussionmentioning

confidence: 99%

Analysis of Risk Factors for Kidney Retransplant Outcomes Associated with Common Induction Regimens: A Study of over Twelve-Thousand Cases in the United States

Santos

Casey

Womer

2017

Journal of Transplantation

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We studied registry data of 12,944 adult kidney retransplant recipients categorized by induction regimen received into antithymocyte globulin (ATG) (N = 9120), alemtuzumab (N = 1687), and basiliximab (N = 2137) cohorts. We analyzed risk factors for 1-year acute rejection (AR) and 5-year death-censored graft loss (DCGL) and patient death. Compared with the reference, basiliximab: (1) one-year AR risk was lower with ATG in retransplant recipients of expanded criteria deceased-donor kidneys (HR = 0.56, 95% CI = 0.35–0.91 and HR = 0.54, 95% CI = 0.27–1.08, resp.), while AR risk was lower with alemtuzumab in retransplant recipients with >3 HLA mismatches before transplant (HR = 0.63, 95% CI = 0.44–0.93 and HR = 0.81, 95% CI = 0.63–1.06, resp.); (2) five-year DCGL risk was lower with alemtuzumab, not ATG, in retransplant recipients of African American race (HR = 0.54, 95% CI = 0.34–0.86 and HR = 0.73, 95% CI = 0.51–1.04, resp.) or with pretransplant glomerulonephritis (HR = 0.65, 95% CI = 0.43–0.98 and HR = 0.82, 95% CI = 0.60–1.12, resp.). Therefore, specific risk factor-induction regimen combinations may predict outcomes and this information may help in individualizing induction in retransplant recipients.

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Section: Discussionmentioning

confidence: 99%

Analysis of Risk Factors for Kidney Retransplant Outcomes Associated with Common Induction Regimens: A Study of over Twelve-Thousand Cases in the United States

Santos

Casey

Womer

2017

Journal of Transplantation

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“…It is reasonable to assert that alemtuzumab may be a good choice for high risk black transplant recipients. Although, alemtuzumab already has proven its usefulness in this regard in previous study [25,26].…”

Section: Discussionmentioning

confidence: 99%

Alemtuzumab Equalizes Short Term Outcomes in High Risk PRA Patients: Long Term Outcomes Suffer

M¹,

Ad²,

Ekwenna³

et al. 2017

J Clin Exp Transplant

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“…We are not the first to show the reduction of ethnic disparities between AA and White recipients beyond the first posttransplant year after induction with alemtuzumab. 25 Smith and associates found that, in patients who did not receive alemtuzumab, White recipients had significantly lower rates of graft failure than AA recipients (14.9% vs 44.4%; P = .0156). 25 However, in patients who received alemtuzumab, no significant differences in allograft failure rates between White and AA patients existed (5.7% vs 9.4%; P = .8248).…”

Section: Figure 3 Patient Survival By Race/ethnicitymentioning

confidence: 99%

“…Smith and associates proposed that the simplicity of alemtuzumab induction therapy (a onetime, perioperative dose) could have an effect on increasing patient adherence and thereby increasing favorable outcomes. 25 As mentioned previously, genetic factors seem to play a role in increasing the risk of chronic kidney disease and end-stage renal disease in AA patients. [27][28][29][30][31] Therefore, it is plausible that genetic factors could also be partially responsible for improving outcomes in AA patients induced with alemtuzumab.…”

Section: Figure 3 Patient Survival By Race/ethnicitymentioning

confidence: 99%

Alemtuzumab Induction Is Associated With an Equalization of Outcomes Between White and African American Kidney Transplant Recipients

Brooks

Mitro²,

DeLeonibus³

et al. 2019

Exp Clin Transplant

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Objectives: Our aim was to assess outcomes in White and African American kidney transplant recipients after induction with alemtuzumab. Materials and Methods:We performed a retrospective study of 464 patients who received deceased-donor kidney transplants and were induced with alem tuzumab between March 2006 and May 2015. We evaluated ethnic influences on patient and graft survival, delayed graft function, allograft failure, and rejection. Results: There were 337 White (67.3%) and 127 African American (25.3%) patients. We observed no significant differences in 1-, 3-, 5-, and 7-year death-censored graft survival. We also observed no significant differences in 1-, 3-, and 5-year patient survival rates. Having African American ethnicity was not a significant predictor of rejection, graft survival, or patient survival. Conclusions: Our results indicate that recipient ethnicity is not a predictor of rejection, graft survival, or patient survival. White and African American kidney transplant recipients induced with alemtuzumab experienced an equalization of outcomes.

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Racial Disparity in Renal Transplantation

Abstract: This is the first study to describe the effects of AL induction therapy on AA renal transplant recipients beyond the first posttransplant year. Our early results suggest that AL induction therapy abolishes the disparity in renal allograft failure.

Cited by 11 publications

References 16 publications

Analysis of Risk Factors for Kidney Retransplant Outcomes Associated with Common Induction Regimens: A Study of over Twelve-Thousand Cases in the United States

Analysis of Risk Factors for Kidney Retransplant Outcomes Associated with Common Induction Regimens: A Study of over Twelve-Thousand Cases in the United States

Alemtuzumab Equalizes Short Term Outcomes in High Risk PRA Patients: Long Term Outcomes Suffer

Alemtuzumab Induction Is Associated With an Equalization of Outcomes Between White and African American Kidney Transplant Recipients

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