Outcomes of simultaneous kidney-pancreas transplantation in African-American recipients: A case-control study

Introduction. Previous studies have suggested that African-American (AA) et hnicity is a risk factor for rejection and graft loss after kidney transpla ntation. However, little data is available regarding outcomes after simulta neous kidney-pancreas transplantation (SKPT) in AA recipients. The objectiv e of this study was to compare the outcomes of SKPT in AA patients to match ed Caucasian patients as controls. Methods. From January 1996 to September 1999, we performed 79 SKPTs, includ ing 10 in AA recipients. Ten Caucasian controls were selected and matched f or age, gender, weight, timing and technique of transplantation. and immuno suppressive regimen. Clinical outcomes were collected and compared between the two groups. Results. The two groups were well matched for donor and recipient demograph ic, immunologic and transplant characteristics, including 2 patients in eac h group with type 2 diabetes. All patients received tacrolimus (TAC), mycop henolate mofetil (MMF) and steroids, and about half in each group received antibody induction therapy. Patient survival was 100% in both groups with a mean follow-up of 18 months (range 6-47). Kidney and pancreas graft surviv al rates were both 80% in the AA and 100% in the Caucasian groups, respecti vely (p = 0.14). All but one kidney (in the AA group) and all pancreas graf ts experienced immediate function. There were two immunologic kidney and tw o immunologic pancreas graft losses in the AA group. No grafts were lost du e to technical problems. The mean length of initial hospital stay was 16 d in the AA group compared to 10 d in the Caucasian group (p = 0.07). The AA group had a slight increase in the number of readmissions (mean 2.2 AA vs. 1.6 Caucasian, p = 0.08). The incidence of biopsy-proven pancreas acute rej ection was significantly higher in the AA group (50%) compared to the Cauca sian group (10%) (p = 0.05). The incidence of either kidney or pancreas acu te rejection was also higher in the AA group (60% AA vs. 20% Caucasian, p = 0.06). TAC levels were comparable at specific times after transplantation, although there was a trend toward higher doses of TAC in the AA group to a chieve therapeutic levels. The incidences of relaparotomy (30% AA vs. 20% C aucasian) and major infection ( 40% AA vs. 60% Caucasian) were similar betw een groups. Renal and pancreas allograft functions were comparable between groups at specific times after transplantation. Conclusions. These results: suggest that SKPT in AA recipients may be assoc iated with a higher incidence of rejection and immunologic graft loss compa red to matched Caucasian controls.