Renal Transplantation in Black Americans

Young, Carlton J.; Gaston, Robert S.

doi:10.1056/nejm200011233432107

Cited by 250 publications

(232 citation statements)

References 82 publications

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“…[2][3][4][5]18,25,26 Black Americans have lower access to renal transplantation than white Americans, probably because of lower referral rates for transplantation assessment, which may themselves be due to physician attitudes about poor adherence and lower graft success rates among black patients. 17,22,27,28 Numerous studies from the United States also show inferior graft outcomes among black transplant recipients.…”

Section: Discussionmentioning

confidence: 99%

“…This biologic argument has been used to explain differences in outcomes among black and white Americans for decades, but recent studies have shown that it likely plays a minor role in influencing transplant outcomes. 11,13,14,19,25,29,30 A second possible explanation for differences in graft failure in black Americans versus black Canadians is that relative levels of comorbidity may differ between the two populations. For example, a large proportion of black Americans have hypertension listed as their primary renal diagnosis, 1 whereas this was not the case in our study of the Canadian dialysis population during 1990 through 2000.…”

Section: Discussionmentioning

confidence: 99%

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Similar Outcomes among Black and White Renal Allograft Recipients

Yeates¹,

Wiebe²,

Gill³

et al. 2009

Journal of the American Society of Nephrology

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Black renal transplant recipients experience shorter graft survival than white recipients, but no published data describe the graft outcomes among black Canadian recipients. Here, we analyzed data from the Canadian national renal replacement therapy registry, which included 20,243 incident dialysis patients (3% black, 97% white), 5036 of whom received a renal transplant during the study period. Black patients were significantly less likely to receive a renal transplant (deceased and living-donor combined) when compared with white patients (hazard ratio 0.59; 95% confidence interval 0.51 to 0.69; P Ͻ 0.0001). Among patients who underwent a renal transplant, there was no significant difference in the likelihood of graft failure between black and white patients, even after adjustment for comorbidities and socioeconomic status; black patients, however, had significantly lower posttransplantation mortality compared with white patients (hazard ratio 0.49; 95% confidence interval 0.28 to 0.88; P ϭ 0.02). In conclusion, graft outcomes between black and white Canadian renal transplant patients are similar. Because this differs from the experience reported from the United States, further direct comparisons between the two populations is warranted.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Similar Outcomes among Black and White Renal Allograft Recipients

Yeates¹,

Wiebe²,

Gill³

et al. 2009

Journal of the American Society of Nephrology

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“…Despite many advances in immunosuppressive therapies, increased HLA matching and the use of living-related donors (LRD), the incidence of renal allograft failure among Blacks remains disproportionately high. In contrast, studies of Asians with highly mismatched grafts indicate that their graft survival rate is equal or superior to Whites (18,19).…”

Section: Introductionmentioning

confidence: 99%

Ethnicity Greatly Influences Cytokine Gene Polymorphism Distribution

Hoffmann

Stanley

Cox

et al. 2002

American Journal of Transplantation

290

200

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Polymorphisms in the regulatory regions of cytokine genes are associated with high and low cytokine production and may modulate the magnitude of alloimmune responses following transplantation. Ethnicity influences allograft half-life and the incidence of acute and chronic rejection. We have questioned whether ethnic-based differences in renal allograft survival could be due in part to inheritance of cytokine polymorphisms. To address that question, we studied the inheritance patterns for polymorphisms in several cytokine genes (IL-2, IL-6, IL-10, TNF-a, TGF-b, and IFNg) within an ethnically diverse study population comprised of 216 Whites, 58 Blacks, 25 Hispanics, and 31 Asians. Polymorphisms were determined by allele-specific polymerase chain reaction and restriction fragment length analysis. We found striking differences in the distribution of cytokine polymorphisms among ethnic populations. Specifically, significant differences existed between Blacks and both Whites and Asians in the distribution of the polymorphic alleles for IL-2. Blacks, Hispanics and Asians demonstrated marked differences in the inheritance of IL-6 alleles and IL-10 genotypes that result in high expression when compared with Whites. Those of Asian descent exhibited an increase in IFN-g genotypes that result in low expression as compared to Whites. In contrast, we did not find significant ethnic-based differences in the inheritance of polymorphic alleles for TNF-a. Our results show that the inheritance of certain cytokine gene polymorphisms is strongly associated with ethnicity. These differences may contribute to the apparent influence of ethnicity on allograft outcome.

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“…[7][8][9][10] The increased risk for kidney disease in minorities has been attributed to increased rates of diabetes and hypertension exacerbated by limited access to preventive strategies. 10 -12 Once patients develop kidney failure, however, racial disparities in health care delivery are at least partially attenuated because universal access to dialysis is mandated in the United States regardless of race, insurance, or socioeconomic status.…”

mentioning

confidence: 99%

Impact of Activated Vitamin D and Race on Survival among Hemodialysis Patients

Wolf¹,

Betancourt

Chang

et al. 2008

Journal of the American Society of Nephrology

153

111

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Contrary to most examples of disparities in health outcomes, black patients have improved survival compared with white patients after initiating hemodialysis. Understanding potential explanations for this observation may have important clinical implications for minorities in general. This study tested the hypothesis that greater use of activated vitamin D therapy accounts for the survival advantage observed in black and Hispanic patients on hemodialysis. In a prospective cohort of non-Hispanic white (n ϭ 5110), Hispanic white (n ϭ 979), and black (n ϭ 3214) incident hemodialysis patients, higher parathyroid hormone levels at baseline were the primary determinant of prescribing activated vitamin D therapy. Median parathyroid hormone was highest among black patients, who were most likely to receive activated vitamin D and at the highest dosage. One-year mortality was lower in black and Hispanic patients compared with white patients (16 and 16 versus 23%; P Ͻ 0.01), but there was significant interaction between race and ethnicity, activated vitamin D therapy, and survival. In multivariable analyses of patients treated with activated vitamin D, black patients had 16% lower mortality compared with white patients, but the difference was lost when adjusted for vitamin D dosage. In contrast, untreated black patients had 35% higher mortality compared with untreated white patients, an association that persisted in several sensitivity analyses. In conclusion, therapy with activated vitamin D may be one potential explanation for the racial differences in survival among hemodialysis patients. Further studies should determine whether treatment differences based on biologic differences contribute to disparities in other conditions.

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Renal Transplantation in Black Americans

Cited by 250 publications

References 82 publications

Similar Outcomes among Black and White Renal Allograft Recipients

Similar Outcomes among Black and White Renal Allograft Recipients

Ethnicity Greatly Influences Cytokine Gene Polymorphism Distribution

Impact of Activated Vitamin D and Race on Survival among Hemodialysis Patients

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