Kidney transplantation outcomes in African-, Hispanic- and Caucasian-Americans with lupus

• Published in: Lupus Vol. 21; no. 1; pp. 3 - 12
• Main Authors: Contreras, G, Mattiazzi, A, Schultz, DR, Guerra, G, Ladino, M, Ortega, LM, Garcia-Estrada, M, Ramadugu, P, Gupta, C, Kupin, WL, Roth, D
• Format: Journal Article
• Language: English
• Published: London, England SAGE Publications 01-01-2012; Sage Publications Ltd
• Subjects: Adult; African Americans; Cytomegalovirus; Ethnic Groups; European Continental Ancestry Group; Female; Graft Rejection - immunology; Graft Survival - immunology; Hispanic Americans; Humans; Insurance coverage; Kidney Transplantation - immunology; Lupus; Middle Aged; Risk Factors; Transplantation, Homologous - immunology; Treatment Outcome; Young Adult; United States > US; subacute lupus erythematosus; kidney transplantation; race and ethnicity
• ISSN: 0961-2033; 1477-0962
• DOI: 10.1177/0961203311421208

African-American recipients of kidney transplants with lupus have high allograft failure risk. We studied their risk adjusting for: (1) socio-demographic factors: donor age, gender and race-ethnicity; recipient age, gender, education and insurance; donor–recipient race-ethnicity match; (2) immunologic factors: donor type, panel reactive antibodies, HLA mismatch, ABO blood type compatibility, pre-transplant dialysis, cytomegalovirus risk and delayed graft function (DGF); (3) rejection and recurrent lupus nephritis (RLN). Two thousand four hundred and six African-, 1132 Hispanic-, and 2878 Caucasian-Americans were followed for 12 years after transplantation. African- versus Hispanic- and Caucasian-Americans received more kidneys from deceased donors (71.6%, 57.3% and 55.1%) with higher two HLA loci mismatches for HLA-A (50%, 39.6% and 32.4%), HLA-B (52%, 42.8% and 35.6%) and HLA-DR (30%, 24.5% and 21.1%). They developed more DGF (19.5%, 13.6% and 13.4%). More African- versus Hispanic- and Caucasian-Americans developed rejection (41.7%, 27.6% and 35.9%) and RLN (3.2, 1.8 and 1.8%). 852 African-, 265 Hispanic-, and 747 Caucasian-Americans had allograft failure (p < 0.0001). After adjusting for transplant era, socio-demographic-immunologic differences, rejection and RLN, the increased hazard ratio for allograft failure of African- compared with Caucasian-Americans became non-significant (1.26 [95% confidence interval 0.78–2.04]). African-Americans with lupus have high prevalence of risk factors for allograft failure that can explain poor outcomes.