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

G. Contreras, A. Mattiazzi, Duane R. Schultz, G. Guerra, M. Ladino, L. M. Ortega, M. Garcia-Estrada, P. Ramadugu, C. Gupta, W. L. Kupin, D. Roth

Research output: Contribution to journalArticle

12 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)3-12
Number of pages10
JournalLupus
Volume21
Issue number1
DOIs
StatePublished - Jan 1 2012

Keywords

  • kidney transplantation
  • race and ethnicity
  • subacute lupus erythematosus

ASJC Scopus subject areas

  • Rheumatology

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