Differences In Clinical Outcomes Between African-American (AA) And Caucasian-American (CA) Kidney Transplant Recipients

2.50
Hdl Handle:
http://hdl.handle.net/10755/166072
Category:
Abstract
Type:
Presentation
Title:
Differences In Clinical Outcomes Between African-American (AA) And Caucasian-American (CA) Kidney Transplant Recipients
Author(s):
Johnson, Cheryl
Author Details:
Cheryl Johnson, PhD, Assistant Professor, University of Tennessee at Memphis, Memphis, Tennessee, USA, (updated February 2015) email: cheryl.joy@bchs.edu
Abstract:
Purpose: The purpose of this study was to determine if differences existed in clinical outcomes between AAs and CAs in our kidney transplant population. Rationale: According to recent transplant registry data, the functional graft survival time in AAs receiving cadaver or living donor kidneys is only one-half as long as the graft survival time for comparable grafts in CAs. This disparity in graft survival increases over time for living donor as well as cadaveric AA kidney transplant recipients and has been attributed to irreversible graft rejection. Graft loss returns these patients to an illness state, increases morbidity, depletes a limited organ resource, and exacts an economic toll with AA recipients returning to the waiting list, as a result of a failed transplant, at twice the rate of CAs. Differences in clinical outcomes between AAs and CAs in our kidney transplant population, if found to exist, may result in the design of studies to identify mechanisms responsible for this racial disparity and eventually lead to interventions that will improve outcomes. Design/Method: A retrospective study design was employed to gather demographic data and clinical outcomes from chart reviews of 211 adult primary kidney transplant recipients (117 AAs and 94 CAs). Demographic data consisted of recipient and donor age, race, and gender. Clinical outcomes evaluated were renal function measured by serum creatinine; graft rejection, and loss. Data were evaluated in terms of HLA-DR mismatch (MM) between recipient and donor (i.e., zero, one, or two MMs) as MM is considered to be of critical importance in organ rejection. Statistical analyses were accomplished using chi squares for graft rejection and loss, analysis of variance with multiple pre-planned comparisons of LS Means to determine differences between and within groups on creatinine levels, and Kaplan-Meier Survival estimates for graft survival rates. Results: Serum creatinine was consistently higher in AAs with each increase in DR MM compared to CAs, although only significant when there were two MMs (2.00, 2.67. 3.43 for 0MM, 1MM, 2MMs respectively; p<=0.05). Rejection, but not graft loss, was found to increase for CAs (p<0.05) as the level of DR MM increased. By contrast, in AA recipients, rejection was not associated with the level of MM, but graft loss increased with increased levels of DR MM (p<0.05). While there was no difference in rejection between AA and CA kidney transplant recipients at any level of DR MM, AAs were 1.4 times more likely to experience rejection than CAs when the DR MM was one, and 2.1 times more likely to reject when the DR MM was two. There was no statistically significant difference in graft survival between AAs and CAs in association with DR MM, however AAs with 2 DR MMs manifested clinically significant worsening of survival rates and had the lowest rates at 1,2, and 3 years (89%, 83%, 75%). Conclusions: The findings of this study support the existence of differences in clinical outcomes between AAs and CAs in our kidney transplant population. AAs appear to have a greater risk for impaired renal function (as indicated by increases in serum creatinine), and a greater incidence of graft rejection and loss with increasing levels of DR MM.
Repository Posting Date:
27-Oct-2011
Date of Publication:
27-Oct-2011
Conference Host:
Southern Nursing Research Society
Note:
This is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.

Full metadata record

DC FieldValue Language
dc.type.categoryAbstracten_US
dc.typePresentationen_GB
dc.titleDifferences In Clinical Outcomes Between African-American (AA) And Caucasian-American (CA) Kidney Transplant Recipientsen_GB
dc.contributor.authorJohnson, Cherylen_US
dc.author.detailsCheryl Johnson, PhD, Assistant Professor, University of Tennessee at Memphis, Memphis, Tennessee, USA, (updated February 2015) email: cheryl.joy@bchs.eduen_US
dc.identifier.urihttp://hdl.handle.net/10755/166072-
dc.description.abstractPurpose: The purpose of this study was to determine if differences existed in clinical outcomes between AAs and CAs in our kidney transplant population. Rationale: According to recent transplant registry data, the functional graft survival time in AAs receiving cadaver or living donor kidneys is only one-half as long as the graft survival time for comparable grafts in CAs. This disparity in graft survival increases over time for living donor as well as cadaveric AA kidney transplant recipients and has been attributed to irreversible graft rejection. Graft loss returns these patients to an illness state, increases morbidity, depletes a limited organ resource, and exacts an economic toll with AA recipients returning to the waiting list, as a result of a failed transplant, at twice the rate of CAs. Differences in clinical outcomes between AAs and CAs in our kidney transplant population, if found to exist, may result in the design of studies to identify mechanisms responsible for this racial disparity and eventually lead to interventions that will improve outcomes. Design/Method: A retrospective study design was employed to gather demographic data and clinical outcomes from chart reviews of 211 adult primary kidney transplant recipients (117 AAs and 94 CAs). Demographic data consisted of recipient and donor age, race, and gender. Clinical outcomes evaluated were renal function measured by serum creatinine; graft rejection, and loss. Data were evaluated in terms of HLA-DR mismatch (MM) between recipient and donor (i.e., zero, one, or two MMs) as MM is considered to be of critical importance in organ rejection. Statistical analyses were accomplished using chi squares for graft rejection and loss, analysis of variance with multiple pre-planned comparisons of LS Means to determine differences between and within groups on creatinine levels, and Kaplan-Meier Survival estimates for graft survival rates. Results: Serum creatinine was consistently higher in AAs with each increase in DR MM compared to CAs, although only significant when there were two MMs (2.00, 2.67. 3.43 for 0MM, 1MM, 2MMs respectively; p<=0.05). Rejection, but not graft loss, was found to increase for CAs (p<0.05) as the level of DR MM increased. By contrast, in AA recipients, rejection was not associated with the level of MM, but graft loss increased with increased levels of DR MM (p<0.05). While there was no difference in rejection between AA and CA kidney transplant recipients at any level of DR MM, AAs were 1.4 times more likely to experience rejection than CAs when the DR MM was one, and 2.1 times more likely to reject when the DR MM was two. There was no statistically significant difference in graft survival between AAs and CAs in association with DR MM, however AAs with 2 DR MMs manifested clinically significant worsening of survival rates and had the lowest rates at 1,2, and 3 years (89%, 83%, 75%). Conclusions: The findings of this study support the existence of differences in clinical outcomes between AAs and CAs in our kidney transplant population. AAs appear to have a greater risk for impaired renal function (as indicated by increases in serum creatinine), and a greater incidence of graft rejection and loss with increasing levels of DR MM.en_GB
dc.date.available2011-10-27T14:39:38Z-
dc.date.issued2011-10-27en_GB
dc.date.accessioned2011-10-27T14:39:38Z-
dc.conference.hostSouthern Nursing Research Societyen_US
dc.description.noteThis is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.-
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