ASN 2010: Race, Poverty Linked to High Kidney Transplant Failure Rates

African Americans living in the poorest neighborhoods have double the risk of kidney transplant failure compared with white non-Hispanic patients.

It has been documented that African Americans generally experience fewer successful outcomes than other groups in end stage renal disease therapy. How much of this is attributable to genetic conditions, and how much of it relates to other factors, such as location, transportation options and income level?

Sandra Amaral, MD, of Emory University in Atlanta has drawn on databases compiled by the United States Renal Data System, the United States Census and the United Network for Organ Sharing in an attempt to answer those questions. Amaral previously has published research on the donor wait list roadblocks faced by African Americans and other ethnic groups who need kidneys and live in poor or underserved neighborhoods. In her more recent work, she has focused on the monetary and logistical barriers that may contribute to a reduction of successful kidney transplantation outcomes -- including transplants in children -- within these same populations.

More than 18% of patients overall lost their transplant over an average of four years, according to published research. Data indicate that blacks living in the poorest neighborhoods have twice the risk of kidney transplant failure that white non-Hispanic patients do when certain contributing factors are eliminated from consideration. These include kidneys having originated from cadavers, poor donor-recipient match, female gender, older age at time of transplantation, and longer time on dialysis prior to transplantation.

Still, the disparity of transplant success between black and white patients persists even when the above issues are factored in. In neighborhoods where more than 25% of residents fall below federally defined poverty standards, blacks have a transplant failure hazard ratio of 2.46 when compared to white non-Hispanic patients. This ratio falls to 1.40 for blacks and whites living in the wealthiest 5% of neighborhoods.

“We think that there may be socioeconomic differences,” Amaral told a press briefing at Renal Week 2010. What’s more, she said that she suspects that post-transplant handicaps brought on by entrenched poverty may be even more problematic for children.

“Just based on our clinical practice, what we see in patients coming in is that, if you’re poor, it’s harder to get to your appointment, it may be harder to pay for your medicine, and you may live in a household with a single care provider who is really struggling to just feed you, much less make sure that your medicines are given on time every single day.”

Overall, the reasons that kidney transplants fail more often in black patients than in whites is not well understood. “Basically, it looks like black children who receive kidney transplants appear more likely to lose their kidney compared with whites at all socioeconomic levels,” Amaral said. “But this was much more profound in the poorest neighborhoods. It looks like poverty really does make a difference. It makes it harder for you to have a successful transplant.”