Racial and Ethnic Disparities in Graft and Recipient Survival in Elderly Kidney Transplant Recipients

• Type of Material: Article
• Authors: Titilayo Ilori, Emory University; Demilade Adedinsewo, Morehouse School of Medicine; Oluwaseun Odewole, Emory University; Nosayaba Enofe, Emory University; Akinlolu Ojo, University of Michigan; William McClellan, Emory University; Rachel Patzer, Emory University
• Language: English
• Date: 2015-12-01
• Publisher: Wiley
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2015, the Authors. Journal compilation © 2015, The American Geriatrics Society
• Final Published Version (URL): http://dx.doi.org/10.1111/jgs.13845
• Title of Journal or Parent Work: Journal of the American Geriatrics Society
• ISSN: 0002-8614
• Volume: 63
• Issue: 12
• Start Page: 2485
• End Page: 2493
• Grant/Funding Information: This work was supported in part by Health Resources and Services Administration contract 234-2005-370011C.; This study was supported in part from divisional funds of the Department of Nephrology, Emory University Atlanta GA.; This publication was also supported in part by the National Heart, Lung, Blood and Sleep Institute, National Institutes of Health, through Grant Number R25 HL105401.; Titilayo O. Ilori receives educational support from the ACTSI.; REP is supported in part by the National Institute of Minority Health and Health Disparities (R24MD008077).
• Keywords: Gerontology; Science & Technology; elderly; AFRICAN-AMERICANS; kidney transplantation; EXPERIENCE; graft survival; OUTCOMES; RENAL-ALLOGRAFT SURVIVAL; SOLID-ORGAN TRANSPLANTATION; PUBLIC-HEALTH ISSUE; UNITED-STATES; Geriatrics & Gerontology; HISPANIC PARADOX; SOCIOECONOMIC-STATUS; racial disparities; recipient survival; Life Sciences & Biomedicine
• Research Categories: Gerontology; Health Sciences, Epidemiology; Health Sciences, Medicine and Surgery

Abstract

Background/Objectives: The rise in the number of elderly kidney transplant recipients over the past decade makes it increasingly important to understand factors affecting post-transplant outcomes in this population. Our objective was to investigate the racial/ethnic differences in graft and patient survival among elderly kidney transplant recipients. Design: Retrospective Cohort. Setting & Participants: All first-time, kidney-only transplant recipients ≥60 years of age at transplantation in the United Network for Organ Sharing (UNOS) database, transplanted between July 1996 and October 2010, N=44,013. Measurements: Time to graft failure and death obtained from the UNOS database and linkage to the Social Security Death Index. Neighborhood poverty from 2000 U.S. Census geographic data. Results: Of the 44,013 recipients in the sample, 20% were African American, 63% non-Hispanic white, 11% Hispanic, 5% Asian and the rest “other racial groups”. In adjusted Cox models, we found that compared to whites, African Americans were more likely to experience graft failure (HR: 1.23, 95%CI: 1.15, 1.32), while Hispanics, (HR: 0.77, 95%CI: 0.70, 0.85) and Asians (HR: 0.70, 95%CI: 0.61, 0.81) were less likely to experience graft failure. Secondly, compared to whites, African Americans (HR: 0.84, 95%CI: 0.80, 0.88), Hispanics (HR: 0.68, 95%CI: 0.64, 0.72), and Asians (HR: 0.62, 95%CI: 0.57, 0.68) all were less likely to die after renal transplantation. Conclusion: Elderly African Americans are at increased risk of graft failure compared to white transplant recipients, but survive longer after transplantation. Asians have the highest patient and graft survival followed by the Hispanics. Further studies are needed to assess additional factors affecting graft and patient survival including outcomes such as quality of life.