Comparison of the Efficacy of Induction

1
Comparison of the Efficacy of Induction Therapy
in African American vs. Caucasian Kidney
Transplant Recipients James Fleming, PharmD
David J. Taber, PharmD, BCPS Nicole A. Weimert,
PharmD, BCPS MUSC Medical Center/College of
Pharmacy Residency Program Charleston, SC
INTRODUCTION
RESULTS
BASELINE CHARACTERISTICS
Historically, African Americans have been shown
to be at a higher risk for developing acute and
chronic rejection, as well as graft loss, in
kidney transplantation when compared to
Caucasians. African American race has been
identified as an individual risk factor for
rejection and graft loss and has been included
with PRA gt 20, delayed graft function,
retransplantation, and B-cell positive crossmatch
as an indication of an immunologically high
risk recipient. However, there are currently no
published comparisons of long-term outcomes after
kidney transplantation in African Americans
versus Caucasians based on induction therapy.
This retrospective analysis will help determine
the optimal induction agent for both African
Americans and Caucasians based on risk factors
besides race.
Data is currently being collected and evaluated
LIMITATIONS

• Retrospective review
• Not randomized
• Not blinded
• Possible differences in synthesis between data
  collectors
• Incomplete or missing data on some recipients

OBJECTIVES
The objective of this study is to compare the
efficacy of the common induction agents,
interleukin-2 receptor antagonists (IL2-RA) and
antilymphocyte globulins, in African American
versus Caucasian kidney transplant patients. The
primary endpoints will be biopsy-proven acute
cellular rejection (BP-ACR) and death-censored
graft failure, defined as primary nonfunction, a
return to dialysis or need for retransplant. The
secondary endpoints will be incidence of
infections, active CMV disease or viremia, and
cost of therapy.
BIBLIOGRAPHY

• Young CJ, Gaston RS. Renal transplantation in
  black americans. NEJM. 2000 343(21) 1545-52.
• 2. Katznelson S, Gjertson DW, Cecka JM. The
  effect of race and ethnicity on kidney allograft
  outcomes. Clin Transplant. 1995 379-94.
• 3. Andreoni KA, Brayman KL, Guidinger MK, et.al.
  Kidney and pancreas transplantation in the United
  States, 1996-2005. AJT. 2007 7 1359-75.

METHODS
This will be a retrospective analysis of all
adult kidney transplant recipients performed at
MUSC between January 1, 2000 and December 31,
2006. Patients who are gt18 years old will be
included in the analysis. Patients who are lost
to follow-up and with multiple organ transplants
will be excluded. The patients will be separated
into two groups 1) IL2-RAs and 2) antilymphocyte
antibodies. These two groups will be
subcategorized as African American or Caucasian
recipients and the incidence of BP-ACR and
death-censored graft failure will be compared.
Subgroup analyses will be conducted to
differentiate the groups into high-risk patients
or low-risk patients. Patients will be
considered high immunologic risk if they have PRA
gt20, have undergone retransplantation, or have a
cold ischemic time of gt24 hours.
DISCLOSURES
The authors of this presentation have the
following to disclose concerning possible
financial or personal relationships with
commercial entities James Fleming, David Taber,
and Nicole Weimert Nothing to disclose