PMID- 24976221
OWN - NLM
STAT- MEDLINE
DCOM- 20140901
LR  - 20221207
IS  - 1527-9995 (Electronic)
IS  - 0090-4295 (Linking)
VI  - 84
IP  - 1
DP  - 2014 Jul
TI  - Renal transplantations in African Americans: a single-center experience of 
      outcomes and innovations to improve access and results.
PG  - 68-76
LID - S0090-4295(14)00128-9 [pii]
LID - 10.1016/j.urology.2013.12.068 [doi]
AB  - OBJECTIVE: To report a single-center 10-year experience of outcomes of kidney 
      transplantation in African Americans (AAs) vs Caucasian Americans (CA) and to 
      propose ways in which to improve kidney transplant outcomes in AAs, increased 
      access to kidney transplantation, prevention of kidney disease, and acceptance of 
      organ donor registration rates in AAs. METHODS: We compared outcomes of deceased 
      donor (DD) and living donor (LD) renal transplantation in AAs vs CAs in 772 
      recipients of first allografts at our transplant center from January 1995 to 
      March 2004. For DD and LD transplants, no significant differences in gender, age, 
      body mass index, or transplant panel reactive antibody (PRA) existed between AA 
      and CA recipients. RESULTS: Primary diagnosis of hypertension was more common in 
      AA, DD, and LD recipients. Significant differences for DD transplants included 
      Medicaid insurance in 23% AA compared with 7.0% CA (P<.0001) and more frequent 
      diabetes mellitus type 2 in AAs (15% vs 4.1%, P=.0009). Eighty-three percent of 
      AAs had received hemodialysis compared with 72% of CAs (P=.02). AAs endured 
      significantly longer pretransplant dialysis (911+/-618 vs 682+/-526 days CA, P=.0006) 
      and greater time on the waiting list (972+/-575 vs 637+/-466 days CA, P<0001). In DD 
      renal transplants, AAs had more human leukocyte antigen (HLA) mismatches than CAs 
      (4.1+/-1.4 vs 2.7+/-2.1, P<.0001). Mean follow-up for survivors was 7.1+/-2.5 years. 
      Among LD transplants, graft survival and graft function were comparable for AAs 
      and CAs; however, among DD transplants, graft function and survival were 
      substantially worse for AAs (P=.0003). In both LD and DD transplants, patient 
      survival was similar for AAs and CAs. CONCLUSION: Our data show that AAs 
      receiving allografts from LDs have equivalent short- and long-term outcomes to 
      CAs, but AAs have worse short- and long-term outcomes after DD transplantation. 
      As such, we conclude that AAs should be educated about prevention of kidney 
      disease, the importance of organ donor registration, the merits of LD over DD, 
      and encouraged to seek LD options.
CI  - Copyright (c) 2014 Elsevier Inc. All rights reserved.
FAU - Modlin, Charles S Jr
AU  - Modlin CS Jr
AD  - Section of Renal Transplantation, Cleveland Clinic Glickman Urological & Kidney 
      Institute (GUKI), Cleveland, OH; Cleveland Clinic Glickman Urological & Kidney 
      Institute, Minority Men's Health Center (MMHC), Cleveland Clinic, Cleveland, OH. 
      Electronic address: modlinc@ccf.org.
FAU - Alster, Joan M
AU  - Alster JM
AD  - Department of Quantitative Health Sciences, Cleveland Clinic, Lerner Research 
      Institute, Cleveland, OH.
FAU - Saad, Ismail R
AU  - Saad IR
AD  - Section of Renal Transplantation, Cleveland Clinic Glickman Urological & Kidney 
      Institute (GUKI), Cleveland, OH.
FAU - Tiong, Ho Yee
AU  - Tiong HY
AD  - Section of Renal Transplantation, Cleveland Clinic Glickman Urological & Kidney 
      Institute (GUKI), Cleveland, OH.
FAU - Mastroianni, Barbara
AU  - Mastroianni B
AD  - Section of Renal Transplantation, Cleveland Clinic Glickman Urological & Kidney 
      Institute (GUKI), Cleveland, OH.
FAU - Savas, Kathy M
AU  - Savas KM
AD  - Section of Renal Transplantation, Cleveland Clinic Glickman Urological & Kidney 
      Institute (GUKI), Cleveland, OH.
FAU - Zaramo, Carlumandarlo E B
AU  - Zaramo CE
AD  - Section of Renal Transplantation, Cleveland Clinic Glickman Urological & Kidney 
      Institute (GUKI), Cleveland, OH; Cleveland Clinic Glickman Urological & Kidney 
      Institute, Minority Men's Health Center (MMHC), Cleveland Clinic, Cleveland, OH.
FAU - Kerr, Hannah L
AU  - Kerr HL
AD  - Section of Renal Transplantation, Cleveland Clinic Glickman Urological & Kidney 
      Institute (GUKI), Cleveland, OH.
FAU - Goldfarb, David
AU  - Goldfarb D
AD  - Section of Renal Transplantation, Cleveland Clinic Glickman Urological & Kidney 
      Institute (GUKI), Cleveland, OH.
FAU - Flechner, Stuart M
AU  - Flechner SM
AD  - Section of Renal Transplantation, Cleveland Clinic Glickman Urological & Kidney 
      Institute (GUKI), Cleveland, OH.
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PL  - United States
TA  - Urology
JT  - Urology
JID - 0366151
SB  - IM
CIN - Urology. 2014 Jul;84(1):76-7. PMID: 24976222
CIN - Urology. 2014 Jul;84(1):77. PMID: 24976223
MH  - Adolescent
MH  - Adult
MH  - *Black or African American
MH  - Child
MH  - Female
MH  - Health Services Accessibility/*statistics & numerical data
MH  - Humans
MH  - Kidney Transplantation/*statistics & numerical data
MH  - Male
MH  - Middle Aged
MH  - Retrospective Studies
MH  - Tissue Donors
MH  - Tissue and Organ Procurement/*statistics & numerical data
MH  - Treatment Outcome
MH  - *White People
MH  - Young Adult
EDAT- 2014/07/01 06:00
MHDA- 2014/09/02 06:00
CRDT- 2014/07/01 06:00
PHST- 2013/06/20 00:00 [received]
PHST- 2013/12/18 00:00 [revised]
PHST- 2013/12/31 00:00 [accepted]
PHST- 2014/07/01 06:00 [entrez]
PHST- 2014/07/01 06:00 [pubmed]
PHST- 2014/09/02 06:00 [medline]
AID - S0090-4295(14)00128-9 [pii]
AID - 10.1016/j.urology.2013.12.068 [doi]
PST - ppublish
SO  - Urology. 2014 Jul;84(1):68-76. doi: 10.1016/j.urology.2013.12.068.