Nephrology Dialysis Transplantation, Vol 13, Issue 3 704-710, Copyright © 1998 by Oxford University Press
H Feldman, J Burns, D Roth, J Berlin, L Szczech, R Gayner, S Kushner, K Brayman and R Grossman
Background: Allograft survival among black recipients
is poorer than among whites. Delayed allograft function is associated with
a significant reduction in renal allograft survival. The relationship
between delayed allograft function and black race is incompletely specified
and was the focus of this investigation. Methods: A
non-concurrent study of 325 recipients of cadaveric allografts followed for
the occurrence of delayed allograft function defined as dialysis during the
first week following transplantation for the principal analysis. A
secondary definition of delayed allograft function was formulated based on
the serum creatinine 2 weeks after transplantation. Unadjusted and adjusted
logistic regression analysis were used to examine the unconfounded
relationship between race and delayed allograft function.
Results: Fifty-seven of 91 (62.6%) black recipients
experienced delayed allograft function compared to 113 of 234 (48.3%)
whites. The odds ratio for black race as a predictor of delayed allograft
function was 1.80, P=0.02, (95% CI, 1.09, 2.85). This finding was stable
despite adjustment for other predictors of delayed allograft function in a
multivariate model, but the precision of this estimate was less (P=0.10)
because of missing data. Additionally, adjusted models with imputed values
for missing covariates, models using a secondary definition of delayed
allograft function, and models excluding patients whose cyclosporin therapy
was delayed, all consistently demonstrated a similar association between
black race and delayed allograft function.
Conclusions: This study demonstrated an increased risk
of delayed allograft function among black recipients. This relationship may
play a role in the poorer allograft outcomes experienced by black
recipients. Given the negative effect of delayed allograft function on
allograft survival, efforts to identify its modifiable risk factors should
be a high priority. Key words: cadaveric allograft;
delayed allograft function; kidney transplantation; logistic regression
analysis
ORIGINAL ARTICLES
Race and delayed kidney allograft function
Center for Clinical Epidemiology and Biostatistics and the Department of Biostatistics and Epidemiology, Renal Electrolyte and Hypertension Division, Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Division of Nephrology, St Lukes Hospital, Bethlehem, PA, USA; Health Management Services, SmithKline Beecham, Philadelphia, PA, USA; Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA; Corresponding author at: University of Pennsylvania Medical Center, Center for Clinical Epidemiology and Biostatistics, 720 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104-6201, USA
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