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Influence of Race on Kidney Transplant Outcomes within and outside the Department of Veterans Affairs

Harini A. Chakkera^*, Ann M. O’Hare^*, Kirsten L. Johansen^*, Denise Hynes, Kevin Stroupe, Philip M. Colin and Glenn M. Chertow^*

^* Department of Medicine, Division of Nephrology, University of California, San Francisco, California; and VA Information Resource Center and the Midwest Center for Health Services and Policy Research, Hines VA Hospital, Hines, Illinois

Address correspondence to: Dr. Harini Chakkera, UCSF - Division of Nephrology, HSE 672, 513 Parnassus Avenue, Box 0532, San Francisco, California, 94143-0532. Phone: 415-476-2172; Fax: 415-476-3381; hchakkera{at}att.net

Inferior outcomes after kidney transplantation among African Americans are poorly understood. It was hypothesized that unequal access to medical care among transplant recipients might contribute to worse posttransplantation outcomes among Africian Americans and that racial disparities in kidney transplant outcomes would be less pronounced among patients who receive health care within versus outside the Department of Veterans Affairs (VA), because eligible veterans who receive care within the VA are entitled to receive universal access to care, including coverage of prescription drugs. A study cohort of 79,361 patients who were undergoing their first kidney transplant in the United States between October 1, 1991, and October 31, 2000, was assembled, with follow-up data on graft survival obtained through October 31, 2001. After multivariable proportional hazards adjustment for a wide range of recipient and donor characteristics, African-American patients were at increased risk for graft failure compared with non–African-American patients (relative risk [RR] 1.31; 95% confidence interval [CI] 1.26 to 1.36). African-American race was associated with a similarly increased risk for graft failure among patients who were VA users (RR 1.31; 95% CI 1.11 to 1.54) and non-VA users (RR 1.31; 95% CI 1.26 to 1.36). In conclusion, racial disparities in kidney transplant outcomes seem to persist even in a universal access-to-care system such as the VA. Reasons for worse outcomes among African Americans require further investigation.

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Copyright © 2008 by the American Society of Nephrology. Online ISSN: 1533-3450 Print ISSN: 1046-6673