Sirolimus improves the two-year outcome of renal allografts in African-American patients

Podder, Hemangshu; Podbielski, Jeanette; Hussein, I; Katz, Stephen M.; Buren, C. Van; Kahan, Barry D.

doi:10.1111/j.1432-2277.2001.tb00032.x

Cited by 33 publications

(3 citation statements)

References 32 publications

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“…Recently, changes to the organ allocation system and improvements in immunosuppression regimens have led to reduced disparities with regards to access to deceased donor organs and acute rejection rates; yet, long‐term disparities in graft outcomes remain significant . These long‐term disparities in AAs have traditionally been explained by higher immunologic risks leading to higher rejection rates, socioeconomic status (SES) barriers, increased medication nonadherence, and a higher prevalence and progression of comorbidities …”

Section: Introductionmentioning

confidence: 99%

Pharmacist‐led, technology‐assisted study to improve medication safety, cardiovascular risk factor control, and racial disparities in kidney transplant recipients

Taber

Gebregziabher

Posadas

et al. 2018

J Am Coll Clin Pharm

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Introduction: Health disparities in African-American (AA) kidney transplant recipients compared with non-AA recipients are well established. Cardiovascular disease (CVD) risk control is a significant mediator of this disparity. Objective: To assess the efficacy of improved medication safety, CVD risk control, and racial disparities in kidney transplant recipients. Methods: Prospective, pharmacist-led, technology-aided, 6-month interventional clinical trial. A total of 60 kidney recipients with diabetes and hypertension were enrolled. Patients had to be at least one-year post transplant with stable graft function. Primary outcome measured included hypertension, diabetes, and lipid control using intent-to-treat analyses, with differences assessed between AA and non-AA recipients. Results: The participants mean age was 59 years, with 42% being female and 68% being AA. Overall, patients demonstrated improvements in blood pressure <140/90 mmHg (baseline 50% vs. end of study 68%, p=0.054) and hemoglobin A1c <7% (baseline 33% vs. end of study 47%, p=0.061). AAs demonstrated a significant reduction from baseline in systolic blood pressure (−0.86 mmHg per month, p=0.026), which was not evident in non-AAs (−0.13 mmHg per month, p=0.865). Mean HgbA1c decreased from baseline in the overall group (−0.12% per month, p=0.003), which was similar within AAs (−0.11% per month, p=0.004) and non-AAs (−0.14% per month, p=0.029). There were no changes in low-density lipoproteins, triglycerides, or high-density lipoproteins over the course of the study. Medication errors were significantly reduced and self-reported medication adherence significantly improved over the course of the study. Conclusion: These results demonstrate the potential efficacy of a pharmacist-led, technology-aided, educational intervention in improving medication safety, diabetes, and hypertension and reducing racial disparities in AA kidney transplant recipients. (ClinicalTrials.gov NCT02763943)

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Section: Introductionmentioning

confidence: 99%

Pharmacist‐led, technology‐assisted study to improve medication safety, cardiovascular risk factor control, and racial disparities in kidney transplant recipients

Taber

Gebregziabher

Posadas

et al. 2018

J Am Coll Clin Pharm

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“…Racial disparities in transplant have primarily been attributed to immunologic risk factors in AAs which lead to higher acute rejection rates, 14–16 lower socioeconomic status, 17,18 medication non-adherence, 19,20 reduced access to care 21 and more frequent comorbid conditions. 22–25 Recent studies demonstrate gene variants may also account for this disparity, both in the higher prevalence of ESRD in AAs and the increased risk of graft loss after transplant.…”

Section: Introductionmentioning

confidence: 99%

Twenty years of evolving trends in racial disparities for adult kidney transplant recipients

Taber

Gebregziabher

Hunt

et al. 2016

Kidney International

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Disparities in outcomes for African-American (AA) kidney transplant recipients have persisted for 40 years without a comprehensive analysis of evolving trends in risks associated with this disparity. Here we analyzed United States transplant registry data, which included adult Caucasian or AA solitary kidney recipients transplanted between 1990 and 2009 encompassing 202,085 transplants. Over this 20 year period, the estimated rate of 5 year graft loss decreased from 27.6% to 12.8%. Notable trends in baseline characteristics that significantly differed by race over time included: increased prevalence of diabetes from 2001–09 in AAs (5 year slope difference: 3.4%), longer time on the waiting list (76.5 more days per 5 years in AAs), fewer living donors in AAs from 2003–09 (5 year slope difference: −3.36%), more circulatory death donors in AAs from 2000–09 (5 year slope difference: 1.78%), and a slower decline in delayed graft function in AAs (5 year slope difference: 0.85%). The absolute risk difference between AAs and Caucasians for 5 year graft loss significantly declined over time (−0.92% decrease per 5 years), while the relative risk difference actually significantly increased (3.4% increase per 5 years). These results provide a mixed picture of both promising and concerning trends in disparities for AA kidney transplant recipients. Thus, although the disparity for graft loss has significantly improved, equity is still far off and other disparities, including living donation rates and delayed graft function rates have widened during this time.

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“…Historically, differences in minority outcomes have been attributed in large part to immunologic barriers [human leukocyte antigen (HLA) matching and sensitisation], the transplanted allograft (delayed graft function) and patient variables (noncompliance and co-morbidities). With the advancements in our understanding of transplant immunology, studies comparing white transplant recipients to minority recipients have shown that induction and immunosuppression are no longer prime factors in posttransplant outcomes [2][3][4][5][6][7][8].…”

Section: Historical Thoughtsmentioning

confidence: 99%

Kidney transplant outcomes in minority populations: can we close the gap?

Desai

Sodhi

Akkina

2021

Current Opinion in Organ Transplantation

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Purpose of review Health disparity in minority populations has been increasingly recognized over the last decade. The COVID-19 pandemic sheds a bright light on this very issue impressing upon the need for more research regarding healthcare in disparate populations. Although kidney transplantation remains the treatment of choice for end-stage renal disease management and longevity of life, access to transplantation remains a critical barrier in minority populations. The literature on disparity in access abounds but remains limited with regards to posttransplantation outcomes. The purpose of this review is to draw attention to existing research and literature in posttransplant outcomes and highlight the overall knowledge gap that persists in postkidney transplant care among disparate populations. Recent findings The current review focuses on important paradigm shifts in the determinants of outcomes in posttransplantation care in minority populations. It emphasizes a departure from immune mediated causes to more salient health inequities and socioeconomic factors contributing to patient and graft survival which require further investigation. Summary Despite increased awareness of health disparity in minority populations, outcomes data postkidney transplantation remains sparse. Critical to the future of kidney transplantation and improved healthcare coordination in minority populations will be a deeper understanding of contributing socio-economic variables in disparate outcomes.

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Sirolimus improves the two-year outcome of renal allografts in African-American patients

Cited by 33 publications

References 32 publications

Pharmacist‐led, technology‐assisted study to improve medication safety, cardiovascular risk factor control, and racial disparities in kidney transplant recipients

Pharmacist‐led, technology‐assisted study to improve medication safety, cardiovascular risk factor control, and racial disparities in kidney transplant recipients

Twenty years of evolving trends in racial disparities for adult kidney transplant recipients

Kidney transplant outcomes in minority populations: can we close the gap?

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