Simultaneous Pancreas-Kidney Transplantation in Caucasian versus African American Patients: Does Recipient Ethnicity Influence Outcomes?
Berjesh Sharda1, Komal Gurung1, Robert Stratta1, Alan Farney1, G. Orlando1, C. Jay1, Reeves Daniel2, Mena Gutierrez2, N. Sakhovskaya2, William Doares3, S. Kaczmorski3, Michael D. Gautreaux4, J. Rogers1.
1Transplant Surgery, Wake Forest Baptist Health, Winston Salem, NC, United States; 2Internal Medicine Section of Nephrology, Wake Forest Baptist Health, Winston Salem, NC, United States; 3Pharmacy, Wake Forest Baptist Hospital, Winston Salem, NC, United States; 4Pathology, Wake Forest Baptist Hospital, Winston Salem, NC, United States
Introduction: The influence of African American (AA) recipient ethnicity on outcomes following simultaneous pancreas-kidney transplantation (SPKT).
Methods: From 11/01 to 2/19, we retrospectively studied 158 Caucasian (C) and 57 AA patients (pts) undergoing SPKT at our center. All pts received depleting antibody induction (alemtuzumab - 155, rATG - 60) with tacrolimus/mycophenolate ± steroids maintenance immunosuppression. All pts underwent SPKT with intent-to-treat portal-enteric (PE) drainage (192 PE, 23 systemic-enteric drainage).
Results: Mean follow-up was 97 months C vs 88 months AA; 80% of C and 70% of AA pts had at least 5 years f/u. Mean donor age (27 years C vs 23 AA), recipient age (44 years C vs 40 AA), and pancreas cold ischemia (15 hours) were similar between groups. Recipient gender (41% C female vs 44% AA female) was likewise similar. The AA group had fewer pts on peritoneal dialysis (30% C vs 10% AA), more pts with a longer duration (> 20 months) of dialysis (24% C vs 51% AA), more sensitized (PRA ≥ 20%) patients (6% C vs 19% AA), more 5-6 HLA mismatches (49% C vs 67% AA), more pts with pretransplant C-peptide levels ≥ 2.0 ng/ml (13% C vs 33% AA), and more pts with a shorter duration (< 20 years, 23% C vs 47% AA) and later age of onset (≥ 24 years old) of diabetes (13% C vs 30% AA, all p<0.05). The latter 3 differences suggest that a type 2 diabetes phenotype was more prevalent in the AA group. Overall patient survival (74% C vs 88% AA, p=0.04), kidney (63% C vs 67% AA), and pancreas (57% C vs 61% AA) graft survival rates (GSRs) slightly favored the AA group. Death-censored kidney (77% C vs 73% AA) and pancreas (69% C vs 66% AA) GSRs demonstrated that death with a functioning graft (DWFG) was more common in C (18%) vs AA pts (8%, p=0.05).
Conclusions: SPKT in AA recipients is characterized by longer pretransplant dialysis duration and less peritoneal dialysis, more sensitized patients and HLA-mismatching, and more patients with a type 2 diabetes phenotype. Although pt survival is higher, AA patients are at a greater risk for dual immunological graft loss in the absence of mortality.