RACE AND DELAYED KIDNEY ALLOGRAFT FUNCTION

Background. Allograft survival among black recipients is poorer than a mong whites. Delayed allograft function is associated with a significa nt reduction in renal allograft survival. The relationship between del ayed allograft function and black race is incompletely specified and w as the focus of this investigation. Methods, A non-concurrent study of 325 recipients of cadaveric allografts followed for the occurrence of delayed allograft function defined as dialysis during the first week following transplantation for the principal analysis. A secondary defi nition of delayed allograft function was formulated based on the serum creatinine 2 weeks after transplantation. Unadjusted and adjusted log istic regression analysis were used to examine the unconfounded relati onship between race and delayed allograft function. Results. Fifty-sev en of 91 (62.6%) black recipients experienced delayed allograft functi on compared to 113 of 234 (48.3%) whites. The odds ratio for black rac e as a predictor of delayed allograft function was 1.80, P = 0.02, (95 % CI, 1.09, 2.95). This finding was stable despite adjustment for othe r predictors of delayed allograft function in a multivariate model, bu t the precision of this estimate was less (P = 0.10) because of missin g data. Additionally, adjusted models with imputed values for missing covariates, models using a secondary definition of delayed allograft f unction, and models excluding patients whose cyclosporin therapy was d elayed, all consistently demonstrated a similar association between bl ack race and delayed allograft function. Conclusions, This study demon strated an increased risk of delayed allograft function among black re cipients. This relationship may play a role in the poorer allograft ou tcomes experienced by black recipients. Given the negative effect of d elayed allograft function on allograft survival, efforts to identify i ts modifiable risk factors should be a high priority.