Racial disparity in kidney transplantation: a review and meta-analysis

Background: Racial disparities in outcomes continue to exist, with African Americans (AA) reported to have poorer patient and graft survival compared to their non-AA counterparts. According to a large review conducted looking at historical data (1996-2005), graft survival for AA was about 15% less compared to non-AA. Purpose: The focus of this meta-analysis was to determine the effect size for the differences in patient and graft survival in AA and non-AA patients, and to identify associated factors reported in the literature. Methods: A comprehensive, systematic review search was conducted using MEDLINE, Journals@OVID, PsycINFO, CINAHL and AltHealthWatch databases for studies published after 1999 with keywords of: single-kidney transplant, patient outcomes, graft survival, patient survival, race, ethnicity and disparities. Two reviewers (R.P. and M.S.) reviewed 283 studies, and data on race (AA vs. Non-AA), hypertension, diabetes, human leukocyte antigen (HLA) mismatch, type of donor (deceased or live), and incidence of patient survival and graft survival for 1 and 5 years were extracted independently. Results: Data were collected from 19 articles with a total of 151,285 patients (60% male). The point estimate for odds ratio (OR) for 1-year survival (OR=0.83, P=0.22; I2=0.0, P=0.78) was similar for AA and non-AA, whereas 5-year survival was lower for AA (OR=0.63, PConclusion: Lower long-term survival and higher graft loss for AA was evident. Some of the factors associated with this disparity are hypertension, HLA mismatch and deceased organ donor. Interventional prospective studies are needed to correct factors that could lead to improved patient and graft survival for AA.