Renal allograft outcomes in African American versus Caucasian transplant recipients in the tacrolimus era

Methods. Between January 1995 and December 1999, 185 kidney transplants wer e performed with tacrolimus (TAC)-based immunosuppression including 120 Afr ican American (AA, 65%) and 65 Caucasian recipients (C, 35%). Mean follow-u p was 34 months. The AA group was characterized by a higher incidence of re nal disease due to hypertension (72% AA vs 37% C, P < .001), pre-transplant dialysis (95% AA vs 82% C, P = .003), waiting time (1.9 years ALA vs 1.1 T ears C, P = .02), cadaveric donation (88% AA vs 68% C, P = .01), HLA mismat ching (mean 3.5 AA vs 2.4 C, P < .001), and delayed graft function (DGF; 50 % AA vs 22% C, P = .001). Results. The 5-year actuarial patient and graft survival rates were 96% AA versus 83% C (P = NS) and 83% AA vers its 75% C, (P = NS), respectively. Th e incidence of acute rejection (21% AA vs 12% C, P = NS) and mean time to a cute rejection (12 months AA vs 11 months C) were similar.: Although the in cidence of chronic allograft nephropathy (CAN) was comparable (7% AA vs 5% C), the mean time to CAN was shorter in AA recipients (18 months AA vs 37 m onths C, P = .03). Conclusions. These results suggest marked improvement in post-transplant Ou tcomes in the TAC Ora in patients with multiple immunologic risk factors in cluding AA ethnicity, cadaveric donor source, DGF, and HLA mismatching.