AUA 2018: State-of-the-Art Lecture - Disparities in Urology: Renal Transplant

San Francisco, CA USA ( Charles S. Modlin, MD, from the Cleveland Clinic provided a video presentation on the disparities of renal transplants, focusing on the African American (AA) population group. He indicated that the incidence of end-stage renal disease is 4 times higher in AAs compared to European Americans (EU). The causes behind kidney failure are primarily due to hypertension and diabetes. The AA group has worse renal transplant outcomes compared to EAs and the causes for this disparity tends to be multifactorial. Dr Modlin’s group sought to evaluate these ethnic disparities by examining patients that underwent kidney transplantations over a 10-year period at their institution.

They identified 1400 patients that received either living donor or deceased donor kidneys. They looked at patient demographics, socioeconomic variables (e.g. insurance status), health status including comorbidities, transplantation variables (e.g. time to transplant, rejection, type of dialysis, graft failure, etc.), and mortality.

Their group found that the AA group had higher wait times for a referral to treatment, higher BMI and higher percentage of reactive antibodies. Furthermore, AAs were less likely to receive a living donor kidney compare to EAs. They also found that graft survival was lower in AA compared to EA, but when graft survival was stratified by donor type, there was no difference in survival in those who received living donor allografts. The AA group had higher chronic rejection and immunosuppression non-compliance rates compared to EAs.

Dr Modlin concludes that AAs have worse graft survival for deceased donor kidneys, but ethnic disparities among AAs and EAs disappear when living donor kidneys are used. Finally, Dr Modlin emphasizes a need to promote immunosuppression compliance and living kidney donations among AAs.

Presented by: Charles S. Modlin, MD

Written by: Egor Parkhomenko, Department of Urology, University of California-Irvine at the 2018 AUA Annual Meeting - May 18 - 21, 2018 – San Francisco, CA USA