Noncompliance in living-related donor renal transplantation: the United Network of Organ Sharing Experience

Isaacs, Ross; Conners, A; Nock, S L; Spencer, Chris; Lobo, Peter I.

doi:10.1016/s0041-1345(99)00117-7

Cited by 18 publications

(10 citation statements)

References 4 publications

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“…In a study using USRDS data, Goldfarb-Rumyantev et al15 reported poorer graft survival among patients with low education levels or without private insurance, who were more often African American. More non-compliance leading to graft loss has been reported for African American transplant patients; however, in one study non-compliance was associated with higher incidence of lower socioeconomic status,16 and in another study was found not to account for racial differences in graft survival 17. Cosio et al reported that poorly controlled posttransplant systemic hypertension was associated with poor graft survival in African American but not white patients 18.…”

Section: Discussionmentioning

confidence: 95%

Racial Disparity Trends for Graft Failure in the US Pediatric Kidney Transplant Population, 1980—2004

Chavers

Snyder

Skeans

et al. 2009

American Journal of Transplantation

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Graft survival among adult African American kidney transplant patients remains low compared to whites, but little information is available for children and adolescents. We examined trends in graft failure among US incident primary kidney transplant patients aged <19 years (n = 13 692), 1980-2004. Trends in 1-year and 2-to 5-year graft failure (for patients whose grafts survived the first year) were analyzed in 5-year intervals. One-year graft failure declined 70% for white and 77% for African American patients over the 25-year period, and 1-year graft failure rates improved at a slightly higher rate for African American compared to white patients (p = 0.02). In contrast, the graft failure rates for years 2-5 declined 53% for white and only 41% for African American patients over the 25 years (p = 0.29). In fully adjusted Cox proportional hazards analysis, the rate of graft failure among African Americans was approximately 2-fold higher than for white patients over the entire study period. Graft survival has improved slightly more for African American than white pediatric patients over the past 25 years. However, graft survival for African American pediatric patients remains poor compared with white patients.

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Section: Discussionmentioning

confidence: 95%

Racial Disparity Trends for Graft Failure in the US Pediatric Kidney Transplant Population, 1980—2004

Chavers

Snyder

Skeans

et al. 2009

American Journal of Transplantation

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“…Yet other studies could not demonstrate this relationship after controlling for SES 68,70, 71. As the data are limited, the relationship between race, SES, adherence, and graft survival remains inconclusive 72,73…”

Section: Mechanisms Contributing To Disparitiesmentioning

confidence: 97%

Disparities in Kidney Transplant Outcomes: A Review

Gordon

Ladner

Caicedo

et al. 2010

Seminars in Nephrology

124

112

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Sociocultural and socioeconomic disparities in graft survival, graft function, and patient survival in adult kidney transplant recipients are reviewed. Studies consistently document worse outcomes for black patients, patients with low income, and less education, whereas better outcomes are reported in Hispanic and Asian kidney transplant recipients. However, the distinct roles of racial/ethnic versus socioeconomic factors remain unclear. Attention to potential pathways contributing to disparities has been limited to immunological and nonimmunological factors, for which the mechanisms have yet to be fully illuminated. Interventions to reduce disparities have focused on modifying immunosuppressant regimens. Modifying access to care and health care funding policies for immunosuppressive medication coverage are also discussed. The implementation of culturally sensitive approaches to the care of transplant candidates and recipients is promising. Future research is needed to examine the mechanisms contributing to disparities in graft survival and to ultimately intervene effectively.

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“…Primary cadaveric transplants were predominant in the majority of studies reporting the type of transplant. One study (11) included only transplants from live donors. A median of 61% (43%-85%) of subjects were male.…”

Section: Description Of Studiesmentioning

confidence: 99%

Frequency and impact of nonadherence to immunosuppressants after renal transplantation: a systematic review

Butler

Roderick²,

Mullee³

et al. 2004

Transplantation

490

372

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Nonadherence to immunosuppressants is recognized to occur after renal transplantation, but the size of its impact on transplant survival is not known. A systematic literature search identified 325 studies (in 324 articles) published from 1980 to 2001 reporting the frequency and impact of nonadherence in adult renal transplant recipients. Thirty-six studies meeting the inclusion criteria for further review were grouped into cross-sectional and cohort studies and case series. Meta-analysis was used to estimate the size of the impact of nonadherence on graft failure. Only two studies measured adherence using electronic monitoring, which is currently thought to be the most accurate measure. Cross-sectional studies (n=15) tended to rely on self-report questionnaires, but these were poorly described; a median (interquartile range) of 22% (18%-26%) of recipients were nonadherent. Cohort studies (n=10) indicated that nonadherence contributes substantially to graft loss; a median (interquartile range) of 36% (14%-65%) of graft losses were associated with prior nonadherence. Meta-analysis of these studies showed that the odds of graft failure increased sevenfold (95% confidence interval, 4%-12%) in nonadherent subjects compared with adherent subjects. Standardized methods of assessing adherence in clinical populations need to be developed, and future studies should attempt to identify the level of adherence that increases the risk of graft failure. However, this review shows nonadherence to be common and to have a large impact on transplant survival. Therefore, significant improvements in graft survival could be expected from effective interventions to improve adherence.

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Noncompliance in living-related donor renal transplantation: the United Network of Organ Sharing Experience

Cited by 18 publications

References 4 publications

Racial Disparity Trends for Graft Failure in the US Pediatric Kidney Transplant Population, 1980—2004

Racial Disparity Trends for Graft Failure in the US Pediatric Kidney Transplant Population, 1980—2004

Disparities in Kidney Transplant Outcomes: A Review

Frequency and impact of nonadherence to immunosuppressants after renal transplantation: a systematic review

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