Increasing living kidney donation in African Americans (original) (raw)
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A Decade of Experience With Renal Transplantation in African-Americans
Annals of Surgery, 2002
To evaluate the strategies instituted by the authors' center to decrease the time to transplantation and increase the rate of transplantation for African-Americans, consisting of a formal education program concerning the benefits of living organ donation that is oriented to minorities; a laparoscopic living donation program; use of hepatitis C-positive donors in documented positive recipients; and encouraging vaccination for hepatitis B, allowing the use of hepatitis B core Ab-positive donors. Summary Background Data The national shortage of suitable kidney donor organs has disproportional and adverse effects on African-Americans for several reasons. Type II diabetes mellitus and hypertension, major etiologic factors for end-stage renal disease, are more prevalent in African-Americans than in the general population. Once kidney failure has developed, African-Americans are disadvantaged for the following reasons: this patient cohort has longer median waiting times on the renal transplant list; African-Americans have higher rates of acute rejection, which affects long-term allograft survival; and once they are transplanted, the long-term graft survival rates are lower in this population than in other groups. Methods From March 1990 to November 2001 the authors' center performed 2,167 renal transplants; 944 were in African-Americans (663 primary cadaver renal transplants and 253 primary Living donor renal transplants). The retransplants consisted of 83 cadaver transplants and 17 living donor transplants. Outcome measures of this retrospective analysis included median waiting time, graft and patient survival rates, and the rate of living donation in African-Americans and comparable non-African-Americans. Where applicable, data are compared to United Network for Organ Sharing national statistics. Statistical analysis employed appropriate SPSS applications. Results One-and 5-year patient survival rates for living donor kidneys were 97.1% and 91.3% for non-African-Americans and 96.8% and 90.4% for African-Americans. One-and 5-year graft survival rates were 95.1% and 89.1% for non-African-Americans and 93.1% and 82.9% for African-Americans. One-and 4-year patient survival rates for cadaver donor kidneys were 91.4% and 78.7% for non-African-Americans and 92.4% and 80.2% for African-Americans. One-and 5-year graft survival rates for cadaver kidneys were 84.6% and 73.7% for non-African-Americans and 84.6% and 68.9% for African-Americans. One-and 5-year graft and patient survival rates were identical for recipients of hepatitis C virus-positive and anti-HBc positive donors, with the exception of a trend to late graft loss in the African-American hepatitis C virus group due to higher rates of noncompliance, an effect that disappears with censoring of graft loss from that cause. The cadaveric renal transplant median waiting time for non-African-Americans was 391 days compared to 734 days nationally; the waiting time for African-Americans was 647 days compared to 1,335 days nationally. When looking at all patients, living and cadaver donor, the median waiting times are 220 days for non-African-Americans and 462 days for African-Americans. Conclusions Programs specifically oriented to improve volunteerism in African-Americans have led to a marked improvement in overall waiting time and in rates of living donation in this patient group. The median waiting times to cadaveric renal transplantation were also significantly shorter in the authors' center, especially for African-American patients, by taking advantage of the higher rates of hepatitis C infection and encouraging hepatitis B vaccination. These policies can markedly improve end-stage renal disease care for African-Americans by halving the overall waiting time while still achieving comparable graft and patient survival rates.
Clinical Transplantation, 2011
Kidney transplantation is the renal replacement therapy of choice for end-stage renal disease (ESRD). Over the last 20 yr, the number of waitlisted candidates has increased substantially, with a relatively small increase in the deceased donor pool (1). As a result, there has been increasing need for living kidney donors. Access to living kidney donors has varied among ethnic groups in part because of differences in waitlist representation. African Americans (AA) are overrepresented in the ESRD and kidney transplant waitlist populations (29% and 34%, respectively) (1, 2), relative to their percentage within the US population (13%) (3). However, over 70% of deceased kidney donors are Caucasian (CA). Differences in the distribution of human leukocyte antigens (HLA), antibody sensitization and ABO blood types, these demographic differences often lead to prolonged deceased donor waiting times for AA as opposed to other ethnic groups (1). Despite the growing need, there is a disproportionately lower rate of live kidney donation among AA (1). Previous literature has focused primarily on ethnic differences in living donor willingness, trust in the health care system and completion of donor evaluations as reasons for the lower rates of live kidney donation in AA (4-9). Little attention has been paid to the possibility that medical Norman SP, Song PXK, Hu Y, Ojo AO. Transition from donor candidates to live kidney donors: the impact of race and undiagnosed medical disease states.
Racial Variation in Medical Outcomes among Living Kidney Donors
New England Journal of Medicine, 2010
Background Data regarding health outcomes among living kidney donors are lacking, especially among nonwhite persons. Methods We linked identifiers from the Organ Procurement and Transplantation Network (OPTN) with administrative data of a private U.S. health insurer and performed a retrospective study of 4650 persons who had been living kidney donors from October 1987 through July 2007 and who had post-donation nephrectomy benefits with this insurer at some point from 2000 through 2007. We ascertained post-nephrectomy medical diagnoses and conditions requiring medical treatment from billing claims. Cox regression analyses with left and right censoring to account for observed periods of insurance benefits were used to estimate absolute prevalence and prevalence ratios for diagnoses after nephrectomy. We then compared prevalence patterns with those in the 2005-2006 National Health and Nutrition Examination Survey (NHANES) for the general population. Results Among the donors, 76.3% were white, 13.1% black, 8.2% Hispanic, and 2.4% another race or ethnic group. The median time from donation to the end of insurance benefits was 7.7 years. After kidney donation, black donors, as compared with white donors, had an increased risk of hypertension (adjusted hazard ratio, 1.52; 95% confidence interval [CI], 1.23 to 1.88), diabetes mellitus requiring drug therapy (adjusted hazard ratio, 2.31; 95% CI, 1.33 to 3.98), and chronic kidney disease (adjusted hazard ratio, 2.32; 95% CI, 1.48 to 3.62); findings were similar for Hispanic donors. The absolute prevalence of diabetes among all donors did not exceed that in the general population, but the prevalence of hypertension exceeded NHANES estimates in some subgroups. End-stage renal disease was identified in less than 1% of donors but was more common among black donors than among white donors. Conclusions As in the general U.S. population, racial disparities in medical conditions occur among living kidney donors. Increased attention to health outcomes among demographically diverse kidney donors is needed.
Racial Disparities in Kidney Graft Survival: Does Donor Quality Explain the Difference?
American Journal of Transplantation, 2012
Racial disparities exist in access to kidney transplantation. Despite a threefold higher rate of end stage renal disease among African Americans (AA) compared to Caucasians (1), AAs face significant barriers in access to transplant referral, waitlisting and transplantation (2). Challenges continue for AAs even after organ receipt. As highlighted in the 2010 SRTR data report, 5-year graft survival for deceased donor (DD) transplants was 74.8% (± 0.4%) for Caucasians and 66.3% (±0.5%) for AAs and these differences increase over time (1). The reasons for the disparities are unclear, and are likely multifactorial.
The American Journal of Surgery, 2010
BACKGROUND: Prior studies have demonstrated that African-American (AA) donor kidneys are independently associated with an increased risk for graft loss. METHODS: We examined outcomes in comparable groups of AA deceased-donor (DD) kidney transplant patients receiving an AA donor (n ϭ 35) versus a Caucasian donor (C group; n ϭ 150) organ. RESULTS: There were no differences between AA and C groups in patient survival, new-onset diabetes, or BK nephropathy. The AA group demonstrated a significantly higher 6-month and overall incidence of acute rejection (AR), increased cytomegalovirus (CMV) infection, and decreased graft survival. Recurrent or de novo focal segmental glomerulosclerosis (FSGS) accounted for a significantly higher fraction of graft losses in the AA versus C group. CONCLUSIONS: AA DD renal allograft recipients have equivalent patient but decreased graft survival when transplanted with an AA versus C kidney using current immunosuppression. This may be the result of increased AR, CMV infection, and recurrence/development of FSGS.
Transplantation Proceedings, 2011
Living donor kidney transplantation offers many advantages to the recipients. Longer allograft survival, fewer postoperative complications, and better renal function are some of the benefits of receiving living donor kidneys compared to deceased donor organs. However, the consequences to the donor in terms of renal function are not as well defined. Moreover, it is not clear whether all donors share an equal risk to their renal function following donation regardless to ethnicity, sex, and age. In this retrospective study, we identify and compare the reduction in estimated glomerular filtration rate (eGFR) among ethnic groups, women, and older donors prior to, immediately after, and 1 year postdonation. We compared the percentage decline in renal function among various ages and other demographic groups using individual patients as their own controls. Medical records of 103 consecutive living donors (mean age 40.3 Ϯ 9.6 years) were reviewed. On average, donors experienced a 34.7% fall in eGFR at 273 days posttransplant. A greater decline was noticed in the African-American (AA) group (41% compared to 34% in white patients, P ϭ .03). The majority of the decline in the AA eGFR was among women, in whom the fall was 46% compared to AA men at 31%. White women had a 34% fall in eGFR (P ϭ .02). The percentage decline in eGFR was not different among the different age groups; however, donors older than 50 years had a postdonation eGFR of 55.1 mL/min versus 60.9 mL/min in those less than 50 years old (P ϭ .03), reflecting lower eGFR predonation (older 84.7 mL/min vs younger 95.2 mL/min, P ϭ .02). The percent decline in eGFR did not change with time after donation (0-1 month 37%, 1-12 months 34%, Ͼ1 year 30%). eGFR declines abruptly post-kidney donation in all patients but remains stable and improves afterwards. AA women and older donors are more prone to reduction in eGFR post-kidney donations.
Renal disease and black Americans: Selected issues
Social Science & Medicine, 1993
Black Americans compared with their white counterparts are disproportionately hypertensive and have a greater incidence. of end-stage renal disease (ESRD). Renal disease is a frequent end point of accelerated hypertension. The reasons why black Americans have a higher incidence of ESRD relative to white Americans are explored. As transplantation is a preferred mode of treatment for chronically ill ESRD patients, the paper examines some of the reasons why blacks are more reluctant than whites to donate their organs (e.g. kidneys) for transplantation. Although various reasons affect organ donation, altruism is explored as a possible factor that may influence the willingness of blacks to donate their organs. social and demographic profile of hemodialysis patients in the United States. JAMA 245, 487491, 1981. Anaise D. and Smith R. Equity and organ distribution. Transplant Proc. 21, 338-339, 1989. Eggers P. Effects of transplantation on the medicare end-stage renal disease program. N. Engl. J. Med. 8, 223-229, 1988. 52.
Race, Relationship and Renal Diagnoses After Living Kidney Donation
Transplantation, 2015
In response to recent studies, a better understanding of the risks of renal complications among African American and biologically related living kidney donors is needed. We examined a database linking U.S. registry identifiers for living kidney donors (1987-2007) to billing claims from a private health insurer (2000-2007 claims) to identify renal condition diagnoses categorized by International Classification of Diseases 9th Revision coding. Cox regression with left and right censoring was used to estimate cumulative incidence of diagnoses after donation and associations (adjusted hazards ratios, aHR) with donor traits. Among 4650 living donors, 13.1% were African American and 76.3% were white; 76.1% were first-degree relatives of their recipient. By 7 years post-donation, after adjustment for age and sex, greater proportions of African American compared with white donors had renal condition diagnoses: chronic kidney disease (12.6% vs 5.6%; aHR, 2.32; 95% confidence interval [95% CI...
Health Disparities in Kidney Transplantation for African Americans
American journal of nephrology, 2017
The persistent challenges of bridging healthcare disparities for African Americans (AAs) in need of kidney transplantation continue to be unresolved at the national level. This healthcare disparity is multifactorial: stemming from limited kidney donors suitable for AAs; inconsistent care coordination and suboptimal risk factor control; social determinants, low socioeconomic status, reduced access to care; and mistrust of clinicians and the healthcare system. There are numerous opportunities to significantly lessen the disparities in kidney transplantation for AAs through the following measures: the adoption of new care and patient engagement models that include education, enhanced practice-level cultural sensitivity, and timely referral as well as increased research on the impact of the environment on genetic risk, and implementation of new transplantation-related policies. Key Messages: This systematic review describes pretransplant concerns related to access to kidney transplantat...