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Taber DJ, Su Z, Fleming JN, Pilch NA, Morinelli T, Mauldin P, Dubay D. The impact of time-varying clinical surrogates on disparities in African-American kidney transplant recipients - a retrospective longitudinal cohort study. Transpl Int 2018; 32:84-94. [PMID: 30176087 DOI: 10.1111/tri.13338] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 05/22/2018] [Accepted: 08/20/2018] [Indexed: 01/06/2023]
Abstract
An improved understanding of the impact of clinical surrogates on disparities in African-American (AA) kidney transplantation (KTX) is needed. We conducted a 10-year retrospective longitudinal cohort study of electronically abstracted clinical data assessing the impact of surrogates on disparities in KTX. Clinical surrogates were assessed by posttransplant year (1, 2, 3 or 4) and defined as acute rejection (Banff ≥1A), mean SBP >140 mmHg, tacrolimus variability (CV) >40%, mean glucose >160 mg/dl and mean hemoglobin <10 g/dl. We utilized landmark methodology to minimize immortal time bias and logistic and survival regression to assess outcomes; 1610 KTX were assessed (54.2% AAs), with 1000, 468, 368 and 303 included in the year 1, 2, 3 and 4 complete case analyses, respectively. AAs had significantly higher odds of developing a clinical surrogate, which increased in posttransplant years three and four [OR year 1 1.99 (1.38-2.88), year 2 1.77 (1.20-2.62), year 3 2.35 (1.49-3.71), year 4 2.85 (1.72-4.70)]. Adjusting for the five clinical surrogates in survival models explained a significant portion of the higher risks of graft loss in AAs in post-transplant years three and four. Results suggest focusing efforts on improving late clinical surrogate management within AAs may help mitigate racial disparities in KTX.
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Affiliation(s)
- David J Taber
- Division of Transplant Surgery, College of Medicine, Medical University of South Carolina, Charleston, SC, USA.,Department of Pharmacy Services, Ralph H Johnson VAMC, Charleston, SC, USA
| | - Zemin Su
- Division of General Internal Medicine & Geriatrics, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - James N Fleming
- Division of Transplant Surgery, College of Medicine, Medical University of South Carolina, Charleston, SC, USA.,Department of Pharmacy Services, Medical University of South Carolina, Charleston, SC, USA
| | - Nicole A Pilch
- Transplant Center, Medical University of South Carolina, Charleston, SC, USA
| | - Thomas Morinelli
- Division of Transplant Surgery, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Patrick Mauldin
- Division of General Internal Medicine & Geriatrics, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Derek Dubay
- Division of Transplant Surgery, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
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