EFFECT OF RACE ON OUTCOME AFTER KIDNEY AND KIDNEY-PANCREAS TRANSPLANTATION IN TYPE-1 DIABETIC-PATIENTS

OBJECTIVE The racial impact on graft outcome is not well defined in di abetic recipients. The purpose of this study is to analyze our experie nce with kidney-alone (KA) and kidney-pancreas (KP) transplantation in type 1 diabetic recipients and evaluate the impact of racial disparit y on outcome. RESEARCH AND METHODS - The records of 217 kidney transpl ants (118 KA, 99 KP) performed on type 1 diabetic patients between 198 5 and 1995 at the Medical University of South Carolina and the Univers ity of Texas Medical Branch were reviewed. RESULTS A total of 53 (31%) white patients and 15 (33%) black patients experienced at least one e pisode of biopsy-proven acute rejection of the renal graft (NS). Patie nt survival at 1, 2, and 5 years was similar in white (92, 87, 69%) an d black (91, 91, 69%) patients (NS). Kidney graft survival at 1, 2, an d 5 years in the KA group was 72, 62, and 42% in blacks, compared with 79, 76, and 53% in whites (NS). Kidney graft survival at 1, 2, and 5 years in the KP group was 92, 92, and 74% in blacks, compared with 83, 77, and 58% in whites (NS). Pancreas graft survival at 1, 2, and 5 ye ars was 81, 81, and 81% in blacks, compared with 81, 75, and 62% in wh ites (NS). Cox regression analysis revealed that donor age greater tha n or equal to 40 years increased the risk of renal graft failure 6.2-f old (P = 0.0001), whereas the addition of a pancreas transplant to a k idney and a living-related transplant decreased the risk of failure of the kidney graft 0.2 (P = 0.005) and 0.1 times (P = 0.005). CONCLUSIO NS - Our results suggest that when compared with whites, there may be a trend toward an improved kidney and pancreas graft outcome in blacks undergoing KP transplants. These findings suggest that diabetes may o verride the risk factors that account for the pronounced disparity in outcome observed between nondiabetic white and black recipients.