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Results of renal transplantation in black patients in South Africa
ELSEVIER
Results of Renal Transplantation D. Kahn, F. McCurdie,
A.R. Pontin,
in Black Patients in South Africa
M.D. Pascoe, C.R. Swanepoel,
T
HE IMPACT of race on renal allograft survival remains unresolved. Although some groups have documented poor graft survival in African-Americans, others have not.‘-” Most of the data regarding renal transplantation in Black patients comes from the United States. In this study we report on the results of renal transplantation in Black patients in South Africa. PATIENTS
AND
METHODS
All patients undergoing a renal transplantation at Groote Schuur Hospital, Cape Town, between January 1986 and December 1995 were included in this study. Conventional surgical techniques were used for the procurement of the organs from the donor and the subsequent transplant into the recipient. The kidneys were preserved in either Eurocollins solution or University of Wisconsin solution. The allocation of donor organs was based on ABO compatibility, a negative lymphocytotoxic cross-match, and HLA matching. The immunosuppression protocol consisted of cyclosporine, steroids, and azathioprine. Cyclosporine was discontinued at 6 months after the transplant in patients with stable renal function. RESULTS
During the lo-year study period, we performed 761 renal transplants. These included 174 renal transplants in Black patients. The number of Black patients undergoing renal transplantation increased from 10 in 1986 to 32 in 1994 and constituted 12% and 32% of the patients transplanted, respectively. There were 98 males and the mean age was 34 years (range 12 to 56 years). Twelve patients received grafts from living-related donors and 162 from cadaver donors. There were 147 first grafts, 24 second grafts, and 3 third grafts. The overall patient survival among Black patients was 82% and 65% at 1 and 3 years, respectively. The overall graft survival among Black patients was 67% and 47% at 1 and 3 years, respectively. Of the 162 cadaver kidney transplants among Black patients, 61 were from White donors, 71 were from donors of mixed racial origin, and 30 were from Black donors. The cumulative graft survival among Black recipients at 5 years was similar irrespective of the race of the donor (ie, 40%, 54%, and 41%, respectively). Black recipients of a living-related donor transplant had significantly better graft survivals than recipients of cadaver donor transplants (83% and 43% at 3 years, respectively, P < .Ol). 0 1997 by Elsevier Science Inc. 655 Avenue of the Americas,
New York, NY 10010
Transplantation
29, 3721 (1997)
Proceedings,
B.L. Rayner, and R. Van Zyl-Smit
The cumulative graft survival at 3 years was 47% among Black patients, 57% among White patients, and 51% among patients of mixed racial origin (P > .05). DISCUSSION
The results of renal transplantation in Black patients are reported to be worse, although several single-centre studies have shown no difference in survival. Experience with renal transplantation in Black patients in South Africa has been documented only to a limited extent. We found that the results of renal transplantation in Black patients were similar to the other racial groups. The number of Black patients undergoing renal transplantation has increased over the years as a result of increased urbanisation, accessibility to dialysis, and changes in cultural beliefs. It has been suggested that stronger immunosuppression, more aggressive treatment of acute rejection, and better HLA matching are effective strategies in improving graft survival in Blacks.4-7 Despite poor HLA matching and a policy of stopping cyclosporine after 6 months, we have found equivalent graft survival among racial groups. In conclusion, this study shows that the results of renal transplantation among Black patients in South Africa are equivalent to other racial groups. REFERENCES
1. Butkus DE, Meydroch EF, Raja SS: New Engl J Med 327840, 1992 2. Diethelm AG, Gaston RS, Barger BO: Clin Transplant 5:580, 1991 3. Greenstein SM. Schechner RS, Tellis VA: Transplant Proc 25:2448, 1993 4. Ross W, Solomon J, Reeve R, et al: Transplant Proc 25:2408, 1993 5. Light JA, Kelly JL, Aquino A, et al: Transplant Proc 25:2436, 1993 6. McCauley J, Shapiro R, Woods H, et al: Transplant Proc 252468, 1993 7. Opelz G, Wujciak T, Schwarz V, et al: Transplant Proc 2512443, 1993 From the Renal Transplant Unit, Groote Schuur Hospital, and University of Cape Town, Cape Town, South Africa. Address reprint requests to Professor D. Kahn, Department of Surgery, Medical School, Observatory 7925, Cape Town, South Africa.
0041-l 345/97/$17.00 PII SO041 -1345(97)01085-3
3721
Results of Renal Transplantation D. Kahn, F. McCurdie,
A.R. Pontin,
in Black Patients in South Africa
M.D. Pascoe, C.R. Swanepoel,
T
HE IMPACT of race on renal allograft survival remains unresolved. Although some groups have documented poor graft survival in African-Americans, others have not.‘-” Most of the data regarding renal transplantation in Black patients comes from the United States. In this study we report on the results of renal transplantation in Black patients in South Africa. PATIENTS
AND
METHODS
All patients undergoing a renal transplantation at Groote Schuur Hospital, Cape Town, between January 1986 and December 1995 were included in this study. Conventional surgical techniques were used for the procurement of the organs from the donor and the subsequent transplant into the recipient. The kidneys were preserved in either Eurocollins solution or University of Wisconsin solution. The allocation of donor organs was based on ABO compatibility, a negative lymphocytotoxic cross-match, and HLA matching. The immunosuppression protocol consisted of cyclosporine, steroids, and azathioprine. Cyclosporine was discontinued at 6 months after the transplant in patients with stable renal function. RESULTS
During the lo-year study period, we performed 761 renal transplants. These included 174 renal transplants in Black patients. The number of Black patients undergoing renal transplantation increased from 10 in 1986 to 32 in 1994 and constituted 12% and 32% of the patients transplanted, respectively. There were 98 males and the mean age was 34 years (range 12 to 56 years). Twelve patients received grafts from living-related donors and 162 from cadaver donors. There were 147 first grafts, 24 second grafts, and 3 third grafts. The overall patient survival among Black patients was 82% and 65% at 1 and 3 years, respectively. The overall graft survival among Black patients was 67% and 47% at 1 and 3 years, respectively. Of the 162 cadaver kidney transplants among Black patients, 61 were from White donors, 71 were from donors of mixed racial origin, and 30 were from Black donors. The cumulative graft survival among Black recipients at 5 years was similar irrespective of the race of the donor (ie, 40%, 54%, and 41%, respectively). Black recipients of a living-related donor transplant had significantly better graft survivals than recipients of cadaver donor transplants (83% and 43% at 3 years, respectively, P < .Ol). 0 1997 by Elsevier Science Inc. 655 Avenue of the Americas,
New York, NY 10010
Transplantation
29, 3721 (1997)
Proceedings,
B.L. Rayner, and R. Van Zyl-Smit
The cumulative graft survival at 3 years was 47% among Black patients, 57% among White patients, and 51% among patients of mixed racial origin (P > .05). DISCUSSION
The results of renal transplantation in Black patients are reported to be worse, although several single-centre studies have shown no difference in survival. Experience with renal transplantation in Black patients in South Africa has been documented only to a limited extent. We found that the results of renal transplantation in Black patients were similar to the other racial groups. The number of Black patients undergoing renal transplantation has increased over the years as a result of increased urbanisation, accessibility to dialysis, and changes in cultural beliefs. It has been suggested that stronger immunosuppression, more aggressive treatment of acute rejection, and better HLA matching are effective strategies in improving graft survival in Blacks.4-7 Despite poor HLA matching and a policy of stopping cyclosporine after 6 months, we have found equivalent graft survival among racial groups. In conclusion, this study shows that the results of renal transplantation among Black patients in South Africa are equivalent to other racial groups. REFERENCES
1. Butkus DE, Meydroch EF, Raja SS: New Engl J Med 327840, 1992 2. Diethelm AG, Gaston RS, Barger BO: Clin Transplant 5:580, 1991 3. Greenstein SM. Schechner RS, Tellis VA: Transplant Proc 25:2448, 1993 4. Ross W, Solomon J, Reeve R, et al: Transplant Proc 25:2408, 1993 5. Light JA, Kelly JL, Aquino A, et al: Transplant Proc 25:2436, 1993 6. McCauley J, Shapiro R, Woods H, et al: Transplant Proc 252468, 1993 7. Opelz G, Wujciak T, Schwarz V, et al: Transplant Proc 2512443, 1993 From the Renal Transplant Unit, Groote Schuur Hospital, and University of Cape Town, Cape Town, South Africa. Address reprint requests to Professor D. Kahn, Department of Surgery, Medical School, Observatory 7925, Cape Town, South Africa.
0041-l 345/97/$17.00 PII SO041 -1345(97)01085-3
3721