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Racial Disparity in African American Renal Transplants: Is Alemtuzumab Induction the Great Equalizer?
Alison A. Smith*, Mira John*, Isabelle Dortonne*, Anil S. Paramesh*, Mary Killackey*, Rubin Zhang*, Belinda Lee*, Bernard M. Jaffe, Joseph F. Buell*
Tulane University, New Orleans, LA

Objective: African Americans (AA) renal transplant recipients experience inferior outcomes compared to Caucasians (CA). Numerous unsuccessful attempts have been made to identify specific immunologic and socioeconomic factors contributing to this discrepancy. Our objective was to examine the effect of induction therapy on racial outcomes for renal transplantation.
Methods: Retrospective analysis of outcomes in consecutive adult renal transplant recipients from 2006-2014 was performed. Patients were separated by race and further stratified by induction therapy, alemtuzumab (AL) vs. no alemtuzumab (nAL). Kaplan Meier curves, log rank tests, and hazard ratios (HR) were generated for mortality and allograft survival. Multiple linear regression modeling measured the effect of independent variables (nAL, rejection, delayed graft function, CMV infection) on AA allograft survival.
Results: 433 patients (172 CA and 261 AA) were identified. Mortality was equivalent between CA and AA (23.2% vs. 17.2%, p=0.1068, HR=0.6970) while the incidence of allograft failure was lower for CA vs. AA (9.3% vs. 21.8%, p=0.0037*, HR=2.079). Stratification by induction agent (267 AL vs. 166 nAL induction) found no difference in allograft survival between CA vs. AA with AL induction (5.9% vs. 9.7%, p=0.2364, HR= 1.728) compared to nAL induction (14.2% vs. 42.7%, p=0.0058*, HR=2.296). Multiple linear regression confirmed the strongest predictor for AA allograft failure was nAL induction (p<0.05*).
Conclusions: This is the first study to suggest that a modern induction agent can eliminate the historic racial disparity previously ascribed to AA renal transplant recipients. The results of this study should stimulate further investigations on optimizing healthcare outcomes for AA.


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