AFRICAN-AMERICAN RECIPIENTS OF KIDNEYS FROM LIVING DONORS HAVE SIMILAR GRAFT SURVIVAL AS NON-AFRICAN AMERICAN RECIPIENTS.
AN Arnold, RL Hurwitz, DA Taylor, CE Haisch and LM Rebellato. Sentara Norfolk General Hospital, Norfolk, VA, and PCMH/ East Carolina University School of Medicine Department of Pathology, Greenville, NC.
The differences reported, when renal transplant (TX) graft survival in African-American (AA) recipients is compared to other (OTR) Race recipients (Caucasian and other), has been attributed to several factors which include differences in: ability to HLA type; immune response; disposition to ESRD, and socio/economics. We undertook this retrospective study to see if the difference in graft survival is still seen in the modern era with better HLA typing and new immunosuppressants, and if UNOS-defined mismatches, applied to different matching schemes (Amm, Bmm, DRmm, ABmm, BDRmm, ABDRmm, Rodey-Fuller CREGmm), impact transplant outcome. The patient population consisted of all patients transplanted at our institutions (N=447) between 1995 and 1999 (AA=253, OTR=194, CAD=226, LRD=189, LURD=32; there were more reTX in the OTR CAD group (21.6 vs 13.8%). Outcomes reported are 3-year actuarial graft survival (GS; death with function censored), and rejection-free graft survival at six months (RFS). We found that living donor (LD) transplants did equally well in the AA versus OTR groups (GS 95.0 vs 95.7, RFS 83.1 vs 81.7). In contrast, CAD TXs, when broken down by recipient (R) and donor (D) race (showed a trend, after the second year, for different outcome (AAR-AAD (N=50), AAR-OTRD (N=88), OTRR-AAD (N=7), OTRR-OTRD (N=81): GS- 63.3, 81.5, 100.0, 83.8: RFS- 77.3, 83.3, 85.7, 82.6). Every HLA mismatch scheme examined showed a trend for a "matching effect" in OTR and not in AA. This is exemplified in CAD RFS for 1-2, and 3-6 ABDR mm groups (AA vs OTR: 80.4, 78.8 vs 86.4, 73.4). Zero mm TXs had RFS of 100.0 vs 97.1 (AA vs OTR).
Conclusions: HLA mm show a correlation with CAD TX outcome (GS, RFS) in OTR and not in AA recipients. It is possible that other histocompatibility factors (e.g. Lewis, DQ, DP, VEC, etc.) may impact GS and RFS in AA recipients of CAD TXs. Transplants using living donors offers a better opportunity to screen donors which are prone to ESRD and other factors that may affect graft survival. LRD and LURD results in AA were equal to OTR and offer the best opportunity for successful renal transplantation.