Kidneys donated after cardiac death could reduce disparities for black kidney transplant recipients

Kidneys donated after individuals die from cardiovascular causes may be one of the best options for black patients in need of transplants, according to a study appearing in the October 2008 issue of the Journal of the American Society Nephrology (JASN). The research reveals that utilization of these organs should be expanded in order to reduce racial disparities that exist in renal transplantation. Numerous studies have shown that persistent disparities exist in end-stage renal disease (ESRD) and kidney transplantation. Black patients with ESRD comprise more than a third of the kidney transplant waiting list but are 2.7 times less likely to receive a kidney transplant than their white counterparts. In addition, black patients are more likely to experience kidney failure after transplantation compared with whites.

There is a clear shortage of donor kidneys in the United States, and there are currently more than 70,000 Americans waiting for kidney transplants. Kidneys donated after brain death are currently used for transplantation, but rarely are organs donated after cardiac death. Researchers say that increased recovery and utilization of kidneys donated after cardiac death could help boost the supply of organs available for transplantation. However, it is unclear whether the racial disparities seen in donations made after brain death would also be seen when donations were made after cardiac death.

To examine the issue, Daniel Warren PhD, and Jayme Locke MD, MPH, of the Johns Hopkins Medical Institutions and their colleagues looked at the outcomes of more than 100,000 adults who received a deceased donor kidney transplant between 1993 and 2006.

Among black patients, those who received kidneys from black cardiac death donors had better long-term kidney and patient survival than those who received kidneys from non-black donors. In addition, compared with standard-criteria kidneys from white donors after brain death, kidneys from black donors after cardiac death conferred a 70% reduction in the risk of kidney loss and a 59% reduction in risk for death among black recipients.

The investigators found that racial disparities were less profound when kidneys were donated after cardiac death compared with kidney donations made after brain death. "These findings suggest that kidneys obtained from black donors after cardiac death may afford the best long-term survival for black recipients," the authors conclude.

The authors note that the findings also indicate that increased utilization of kidneys donated after cardiac death has the potential not only to reduce the organ shortage but also to mitigate the existing disparities for black kidney transplant recipients. They add that the racial disparities in organ and patient survival after kidney transplantation need further investigation.

Source: American Society of Nephrology