In:
American Journal of Nephrology, S. Karger AG, Vol. 40, No. 1 ( 2014), p. 19-28
Abstract:
〈 b 〉 〈 i 〉 Background: 〈 /i 〉 〈 /b 〉 There is continued and significant debate regarding the salient etiologies associated with graft loss and racial disparities in kidney transplant recipients. 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 This was a longitudinal cohort study of all adult kidney transplant recipients, comparing patients with early graft loss ( 〈 5 years) to those with graft longevity (surviving graft with at least 5 years of follow-up) across racial cohorts [African-American (AA) and non-AA] to discern risk factors. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 524 patients were included, 55% AA, 151 with early graft loss (29%) and 373 with graft longevity (71%). Consistent within both races, early graft loss was significantly associated with disability income [adjusted odds ratio (AOR) 2.2, 95% CI 1.1-4.5], Kidney Donor Risk Index (AOR 3.2, 1.4-7.5), rehospitalization (AOR 2.1, 1.0-4.4) and acute rejection (AOR 4.4, 1.7-11.6). Unique risk factors in AAs included Medicare-only insurance (AOR 8.0, 2.3-28) and BK infection (AOR 5.6, 1.3-25). Unique protective factors in AAs included cardiovascular risk factor control: AAs with a mean systolic blood pressure 〈 150 mm Hg had 80% lower risk of early graft loss (AOR 0.2, 0.1-0.7), while low-density lipoprotein 〈 100 mg/dl (AOR 0.4, 0.2-0.8), triglycerides 〈 150 mg/dl (AOR 0.4, 0.2-1.0) and hemoglobin A 〈 sub 〉 1C 〈 /sub 〉 〈 7% (AOR 0.2, 0.1-0.6) were also protective against early graft loss in AA, but not in non-AA recipients. 〈 b 〉 〈 i 〉 Conclusions: 〈 /i 〉 〈 /b 〉 AA recipients have a number of unique risk factors for early graft loss, suggesting that controlling cardiovascular comorbidities may be an important mechanism to reduce racial disparities in kidney transplantation.
Type of Medium:
Online Resource
ISSN:
0250-8095
,
1421-9670
Language:
English
Publisher:
S. Karger AG
Publication Date:
2014
detail.hit.zdb_id:
1468523-1
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