Simultaneous pancreas‐kidney transplantation in Caucasian versus African American patients: Does recipient race influence outcomes?

Abstract

The influence of African American (AA) recipient race on outcomes following simultaneous pancreas‐kidney transplantation (SPKT) is uncertain. Methods From 11/01 to 2/19, we retrospectively studied 158 Caucasian (C) and 57 AA patients (pts) undergoing SPKT. Results The AA group had fewer patients on peritoneal dialysis (30% C vs. 14% AA), more patients with longer dialysis duration (28% C vs. 51% AA), more sensitized (PRA ≥20%) patients (6% C vs. 21% AA), and more patients with pretransplant C‐peptide levels ≥2.0 ng/ml (11% C vs. 35% AA, all P < .05). With a mean 9.2 year follow‐up, patient survival (65% C vs. 77% AA, P = .098) slightly favored the AA group, whereas kidney (55% C vs. 60% AA) and pancreas (48% C vs. 54% AA) graft survival rates (GSRs) were comparable. Death‐censored kidney (71% C vs. 68% AA) and pancreas (both 62%) GSRs demonstrated that death with a functioning graft (DWFG) was more common in C vs. AA patients (23% C vs. 12% AA, P = .10). The incidence of death‐censored dual graft loss (usually rejection) was 7% C versus 21% AA (P = .005). Conclusions Following SPKT, AA patients are at a greater risk for dual immunological graft loss whereas C patients are at greater risk for DWFG.

Pancreas Transplantation in Black, Asian and Minority Ethnic Patients-Single Centre Experience in the UK

“…This heterogeneity might also explain similar survival outcomes observed in our study. Although this has been the case, our study supports the more recent observation based on data from the USA that outcomes are not necessarily inferior for non-Caucasian recipients ( 15 – 17 ).…”

Impact of race on pancreas transplant outcomes in the current era: It is not all Black and White

“…Two papers in this month's issue of Clinical transplantation specifically investigate this association, and in parallel illustrate the complexity of defining the association of race with pancreas transplant outcomes from different perspectives. 1,2 Li et al, analyzed pancreas donor and recipient data from the Scientific Registry of Transplant Recipients (SRTR) from 1989 to 2018 to determine the influence of race on pancreatic allograft survival. 2 From 1989 to 2008, Black patients suffered inferior graft survival and higher proportions of graft loss due to rejection, but after 2009 those disparities were reduced such that pancreatic graft failure in Black recipients is now equivalent to Whites and causes of graft failure in Black recipients follow a similar distribution to all other racial and ethnic groups.…”

“…A single center report from Wake Forest Baptist Hospital in North Carolina serves to fill in some of these gaps. 1 Rogers et al report a retrospective analysis of a cohort of simultaneous pancreas and kidney transplant (SPK) recipients from 2002 to 2019 and demonstrate similarly excellent patient and graft survival rates. They also found higher overall survival in Blacks and no differences in graft survival based on race.…”

“…A single center report from Wake Forest Baptist Hospital in North Carolina serves to fill in some of these gaps 1 . Rogers et al.…”

“…Based on prior understanding of the association between recipient race and outcome following pancreas transplantation, one might incorrectly assume that this may lead to an anticipated worsening of pancreas allograft survival in the overall pancreas transplant recipient population based on the change in racial distribution alone. Two papers in this month's issue of Clinical transplantation specifically investigate this association, and in parallel illustrate the complexity of defining the association of race with pancreas transplant outcomes from different perspectives 1,2 …”