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Racial Differences in Graft Survival: A Report from the North American Pediatric Renal Trials and Collaborative Studies (NAPRTCS)

Abiodun Omoloja^*, Mark Mitsnefes, Lynya Talley, Mark Benfield, and Alicia Neu^||

^* Department of Pediatric Nephrology, Wright State University Boonshoft School of Medicine, Dayton, Ohio; Division of Nephrology & Hypertension, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; EMMES Corp., Rockville, Maryland; Division of Pediatric Nephrology, University of Alabama School of Medicine, Birmingham, Alabama; and ^|| Division of Pediatric Nephrology, Johns Hopkins University School of Medicine, Baltimore, Maryland

Address correspondence to: Dr. Alicia Neu, Department of Pediatric Nephrology, Johns Hopkins University School of Medicine, Park 335, Baltimore, MD 21287. Phone: 410-955-2467; Fax: 410-614-3680; E-mail: aneu{at}jhmi.edu

Multiple studies have documented racial differences in graft survival in kidney transplant recipients. Although several studies in adult kidney transplant recipients have evaluated risk factors that might predispose to these differences, studies in pediatric patients are lacking. This study retrospectively analyzed data from the North American Pediatric Renal Trials and Collaborative Studies (NAPRTCS) to identify racial differences in kidney transplant outcomes and evaluate factors that might contribute to those differences. The study was restricted to the first NAPRTCS registry–reported kidney transplant for pediatric patients (age 21 yr) whose race was reported as either black or white. Univariate graft survival analyses were performed using the log rank statistic. Relative hazard rates for the effect of race on graft failure were determined using proportional hazards models. Multivariate analyses were restricted to patients with >30 d of graft survival and were adjusted for initial diagnosis, donor source, presence of delayed graft function, era of transplantation, estimated GFR at 30 d after transplantation, and number of days hospitalized in the first month after transplantation. Graft survival was significantly lower in black transplant recipients at 3 yr (70.9 versus 83.3%) and 5 yr (59.9 versus 77.7%). After controlling for confounding factors, black recipients continued to have a higher risk for graft failure than white recipients (adjusted hazard rate 1.65; 95% confidence interval 1.46 to 1.86). Significant racial differences in kidney transplant outcomes exist among pediatric patients even after controlling for confounding factors.

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