INFERIOR OUTCOME OF 2-HAPLOTYPE MATCHED RENAL-TRANSPLANTS IN BLACKS -ROLE OF EARLY REJECTION

Acute rejection in the early post-transplant period is a major determi nant of long-term outcome. A cohort analysis was performed to evaluate the race-specific incidence rates of early acute rejection episodes ( AR) and delayed graft function (DGF) in Americans of African (blacks) and European (whites) descent (N = 2565) who received a 2-HM living-re lated donor (LRD) first kidney transplant between 1984 and 1992. After adjusting for center and recipient characteristics, blacks had a high er incidence of AR during the initial transplant hospitalization (blac ks 13.2% vs. whites 7.4%, OR = 1.64, P = 0.02). DGF also occurred more frequently in blacks (unadjusted OR = 1.58, P = 0.07). Blacks with AR had significantly worse Cox-adjusted five year graft survival than si milarly affected whites (blacks 50% vs. whites 76%, P < 0.01). We conc lude that failure to take immunosuppressive medications cannot be impl icated as a cause of the higher incidence of AR during the initial tra nsplant hospitalization in black kidney transplant recipients. The exc ess risk of AR in blacks may reflect previously reported intrinsic dif ferences in immune responsiveness and/or pharmacokinetics of immunosup pressive agents. The profound deleterious effect of AR appears to be l argely responsible for the accelerated rate of late graft loss in Afri can Americans.