PEDIATRICS Vol. 89 No. 6 June 1992, pp. 1055-1058
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Effect of Recipient's Race on Pediatric Renal Allograft Survival: A Single-Center Study

Seth L. Schulman MD1, JoAnn Palmer BSN1, Stephen Dunn MD2, Bruce A. Kaiser MD1, Martin S. Polinsky MD1, and H. Jorge Baluarte MD1

1 From the Department of Pediatrics, St Christopher's Hospital for Children and Temple University School of Medicine, Philadelphia. PA.
2 From the Department of Surgery, St Christopher's Hospital for Children and Temple University School of Medicine, Philadelphia. PA.

One hundred twenty-seven children (83 males, 44 females, 86 white, 41 nonwhite; mean age 12.1 years) who received 160 renal transplants between 1980 and 1989 were retrospectively studied. Variables such as age, sex, primary diagnosis, type, HLA-DR mismatching, and repeated transplants were compared between races and found not to be significant. However, HLA-A and -B cadaveric-graft mismatching, which was equivalent between whites and nonwhites prior to 1985 (pre-cyclosporine A era), has significantly favored whites (49% with 0 to 2 HLA-A and -B mismatch vs 16% in nonwhites) since 1985 (P < .05), and a significantly higher proportion of nonwhite patients (59%) were receiving medical assistance (P < .0001). Graft survival was evaluated with significantly poorer results in nonwhites as compared to whites (P < .05). Although no difference was found between white and nonwhite cadaveric-graft survival before 1985, nonwhites had significantly worse graft survival since 1985 (72% vs 59% for 1 year and 61% vs 24% for 3 years in whites and nonwhites, respectively; P < .05). Subpopulations such as nonwhite adolescents, nonwhite females, nonwhites with repeated transplants, and all low socioeconomic patients were identified as high-risk children with poor long-term survival. It is concluded that secondary to poorer matching since 1985 there has been decreased graft survival in nonwhites despite cyclosporine A. Attempts to improve matching and attention to high-risk groups are needed for equivalent survival.

Key Words: renal transplantation • race • graft survival • HLA matching

Submitted on April 19, 1991
Accepted on May 30, 1991


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