Racial Disparity in Renal Transplantation: Alemtuzumab the Great Equalizer?

• Published in: Annals of surgery Vol. 262; no. 4; pp. 669 - 674
• Main Authors: Smith, Alison A, John, Mira M, Dortonne, Isabelle S, Paramesh, Anil S, Killackey, Mary, Jaffe, Bernard M, Buell, Joseph F
• Format: Journal Article
• Language: English
• Published: United States Copyright Wolters Kluwer Health, Inc. All rights reserved 01-10-2015
• Subjects: Adult; African Americans; Aged; Alemtuzumab; Antibodies, Monoclonal, Humanized - therapeutic use; European Continental Ancestry Group; Female; Graft Rejection - ethnology; Graft Rejection - prevention & control; Graft Survival; Health Status Disparities; Humans; Immunosuppressive Agents - therapeutic use; Kaplan-Meier Estimate; Kidney Transplantation; Linear Models; Male; Middle Aged; Retrospective Studies; Transplantation, Homologous; Treatment Outcome
• ISSN: 0003-4932; 1528-1140
• DOI: 10.1097/SLA.0000000000001385

OBJECTIVES:Racial disparity as a barrier to successful outcomes in renal transplants for African Americans has been well described. Numerous unsuccessful attempts have been made to identify specific immunologic and socioeconomic factors. The objective of our study was to determine whether alemtuzumab (AL) induction abolishes this discrepancy and improves allograft survival in African American recipients.
METHODS:A retrospective chart review of consecutive adult renal transplants was conducted between 2006 and 2014. Kaplan-Meier analysis and hazard ratios were calculated for the African Americans (AA) and white groups. Multiple linear regressions were performed to assess independent variables (race, retransplant, sex, donor type, induction agent) on allograft survival.
RESULTS:A significant difference in allograft survival was identified between whites (n = 272) and AA (n = 445), with AA experiencing more graft losses (18.2% vs 12.1%, P = 0.0351). Induction with AL improved outcomes in all transplant recipients. Multiple linear regression identified that the strongest predictor of allograft failure was induction without AL (P < 0.0001). The data for a subset analysis matched for follow-up length demonstrated that whites compared with AA (n = 157, 67 whites and 90 AA) had lower rates of allograft failure in the absence of AL induction (14.9% vs 44.4%, P = 0.0156, hazard ratio = 2.077). In contrast, AL induction (n = 275, 105 whites and 170 AA) eliminated the racial disparity in allograft failure (5.7% vs 9.4%, P = 0.8248, hazard ratio = 1.504).
CONCLUSIONS: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.