Racial effect on kidney transplants.

A Donor race effect 1. In 15 consecutive years from 1971 to 1986, grafts from white donors had a higher graft survival rate than from black donors. 2. The one-year graft survival rate of transplants from white donors was 76.1% compared with 65.6% from black donors (p less than 0.0001) in the period of 1984 to 1987. 3. When analyzed in 3 periods of 1971 to 1980, 1981 to 1983, and 1984 to the present, the higher graft survival rate for white donors compared with black donors was highly significant (p less than 0.0007) in all 3 periods. 4. This difference in survival rates from white and black donors disappeared completely when corrected for center category. Within each category of excellent, good, and fair centers, the survival rate was the same for grafts from white and black donors. The proportion of black-to-white donors was low at the excellent centers and high at the fair centers. 5. We therefore conclude that the donor race effect had been produced by more black donors being utilized at the poorer centers. Once this was corrected, no donor race effect was seen. B. Recipient race effect. 1. In 15 consecutive years from 1971 to 1986, white recipients had a higher graft survival than black recipients. 2. In the period of 1984 to the present, the one-year graft survival was 76.4% for white recipients compared with 69.3% in black recipients (p less than 0.0001). 3. In all 3 periods as given above for the donor race effect, white recipients had a superior survival rate which was highly significant (p less than 0.0001). 4. White recipients had a higher survival rate within all 3 categories of transplant centers. At the fair centers, the one-year graft survival was 72.8% for white recipients and 57.3% for black recipients (p = 0.0004). 5. The overall one-year graft survival of white recipients was 80.5% as compared with 69.5% for black recipients, an 11% difference. Since a higher proportion of black recipients is transplanted at the poorer centers, the corrected one-year graft survival is 74.1%. Thus, the difference of 6.4% is attributed to the recipient race effect and the remaining 4.6% to the center effect. 6. When the 3 categories of centers were examined for various factors, it was noted that black and white recipients had similar cold and warm ischemia times and donor age kidneys and were similar in recipient age.(ABSTRACT TRUNCATED AT 400 WORDS)