The Rocky Road of Limited Immunosuppression for Renal Transplantation in African Americans

The relative risk of overall graft loss and acute rejection among African American renal transplant recipients is attenuated with advancing age

“…Woodward et al (13,28) demonstrated that the relative risk of graft loss among AA recipients is significantly increased after three yr, potentially associated with the discontinuation of immunosuppressive coverage. The role of non-compliance, particularly in younger AAs, has also been implicated as a significant driver in disparities in outcomes which may occur during these later follow-up periods (8,30). This time period also coincides with an interval in which follow-up protocols by transplant centers tend to become less rigorous and the outcomes of center performance evaluations do not have the same consequences (29).…”

“…This time period also coincides with an interval in which follow-up protocols by transplant centers tend to become less rigorous and the outcomes of center performance evaluations do not have the same consequences (29). The role of non-compliance, particularly in younger AAs, has also been implicated as a significant driver in disparities in outcomes which may occur during these later follow-up periods (8,30). It is worthy of note that differences in commercial insurance as a primary payer are highly disparate among younger patients (Table 1), but among older patients (likely based on the provision of Medicare entitlement), differences in private pay insurance are relatively minor.…”

Immunosuppression in high-risk transplantation

“…Furthermore, after transplantation, several studies have reported that African-Americans have inferior graft survival when compared with whites [37,38], with 5-year graft survival for African-Americans significantly inferior (59.1 vs. 72.5%). Although this difference is multifactorial, African-Americans apparently have heightened immune reactivity with increased numbers of activated T cells, blastogenesis and increased costimulatory responses [39,40].…”

Efficacy of induction therapy on acute rejection and graft outcomes in African American kidney transplantation

“…In addition, AAs are often more reluctant to donate and AA recipients are not afforded the substantial benefits of living donor grafts. As a result, AA patients have higher rejection rates and poorer graft outcomes compared to non‐AA patients (4, 9).…”