Studies Explore Racial Discrepancies in Kidney Transplantation
In a recent analysis, whites were twice as likely as blacks to be judged as appropriate candidates for kidney transplantation.
That finding was published in one of two articles in the November 23 issue of The New England Journal of Medicine that dealt with racial issues related to kidney transplantation.
* In one article, Arnold M. Epstein, MD, of Harvard School of Public Health and colleagues
studied 1518 patients with end-stage renal disease (2000;343:1537-1544). According to criteria
developed by an expert panel, 9% of blacks and 21% of whites were appropriate candidates for
transplantation. Blacks were also more likely to have had incomplete evaluations. However,
even after being judged as appropriate candidates for transplantation, blacks still were less
likely to be referred for evaluation, to be placed on a waiting list, or to undergo transplantation.
The authors said that "there was evidence of both underuse of transplantation among blacks and
overuse among whites." See
www.nejm.org/content/2000/0343/0021/1537.asp.
* In a review article, Carlton J. Young, MD, and Robert S. Gaston, MD, of the University of
Alabama at Birmingham looked at the disproportionately high rates of kidney failure in blacks and
the "substantially worse" outcome among blacks than whites after transplantation (2000;343:1545-1552).
"We must improve outcomes for black transplant recipients, whether the remedy is as simple as improved
availability of immunosuppressive drugs or as complicated as defining currently uncharacterized
immunologic pathways," the authors conclude. "Most important, we must ensure that race no longer
limits the access of the most direly affected subgroup of patients with end-stage renal disease to
optimal therapy." See
www.nejm.org/content/2000/0343/0021/1545.asp
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