Racial Disparity in Kidney Transplant Failure Narrows

MedicalResearch.com Interview with:

Tanjala S. Purnell, PhD MPH Assistant Professor, Transplant Surgery and Epidemiology Johns Hopkins University School of Medicine

Dr. Tanjala Purnell

Tanjala S. Purnell, PhD MPH
Assistant Professor, Transplant Surgery and Epidemiology
Johns Hopkins University School of Medicine 

Medical Research: What is the background for this study?

Dr. Purnell:  Kidney transplantation (KT) is the best treatment for most patients with end stage renal disease (ESRD), offering longer life expectancy and improved quality of life than dialysis treatment. Despite these benefits, previous reports suggest that black KT recipients experience poorer outcomes, such as higher kidney rejection and patient death, than white KT recipients. Our team wanted to examine whether this disparity has improved in recent decades. We hypothesized that advances in immunosuppression and post- kidney transplantation  management might differentially benefit black KT recipients, who were disproportionately burdened by immunological barriers, and contribute to reduced racial disparities in kidney transplantation outcomes.

Medical Research: What are the main findings?

Dr. Purnell: 

  1. From 1990 to 2012, 5-year failure rates of the transplanted kidney after Deceased Donor Kidney Transplantation (DDKT) decreased from 51.4% to 30.6% for blacks and from 37.3% to 25.0% for whites; 5-year failure after Living Donor Kidney Transplantation (LDKT) decreased from 37.4% to 22.2% for blacks and from 20.8% to 13.9% for whites.
  2. Among DDKT recipients in the earliest group of patients, blacks were 39% more likely than whites to experience 5-year failure, but this disparity narrowed to 10% in the most recent group.
  3. Among LDKT recipients in the earliest group, blacks were 53% more likely than whites to experience 5-year failure, but this disparity narrowed to 37% in the most recent group.
  4. There were no statistically significant differences in 1-year or 3-year failure rates of transplanted kidneys after LDKT or DDKT in the most recent groups.

Medical Research: What should clinicians and patients take away from your report/

Response: Our research demonstrates a dramatic improvement in kidney transplantation outcomes for black patients and a significant reduction in the disparity in KT outcomes between black and white patients. This may provide clinicians and patients with added confidence to aggressively promote access to KT in the black community. It is important that all patients with ESRD receive timely clinical assessments and access to high-quality information about KT. This may help to address patient concerns and may encourage patients to discuss kidney transplantation as an option with their family members, friends, and members of their extended social members who may also be interested in and suitable to serve as a potential living kidney donor for the patient.

Study investigators include Tanjala S. Purnell, PhD, MPH; Xun Luo, MD, MPH; Lauren M. Kucirka, PhD; Lisa A. Cooper, MD MPH; Deidra Crews, MD, ScM; Allan Massie, PhD; L. Ebony Boulware, MD, MPH; and Dorry L. Segev, MD, PhD. The authors were supported by grants from the National Institutes of Health.

Citation:

J Am Soc Nephrol. 2016 Feb 4. pii: ASN.2015030293. [Epub ahead of print]

Reduced Racial Disparity in Kidney Transplant Outcomes in the United States from 1990 to 2012.

Purnell TS1, Luo X2, Kucirka LM3, Cooper LA4, Crews DC5, Massie AB3, Boulware LE6, Segev DL7.

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Tanjala S. Purnell, PhD MPH (2016). Racial Disparities in Kidney Transplant Failure Narrows