African-American renal transplant recipients experience decreased risk of death due to infection: Possible implications for immunosuppressive strategies

Introduction: African-American renal transplant recipients tend to experience more acute rejection episodes and have shorter graft survival than Caucasian renal transplant recipients. Various factors have been posited to be responsible for this difference, including relative under immunosuppression. We reasoned that by looking at the balance of acute rejections versus death due to infection, we could ascertain whether African- American renal recipients might have more reserve to tolerate an increase in pharmacological immunosuppression. Methods. We analyzed the United States Renal Data System (USRDS) data from 1987 to 1997 regarding acute rejection episodes and infectious deaths. All other pertinent factors were gathered for a multivariate analysis. A total number of 68,885 adult renal transplant recipients were analyzed. Results. When corrected for all covariates, the relative risk for acute rejection (1.3) was higher although the relative risk for infectious death was lower (0.7) in African-Americans as compared with Caucasians (P<0.01). Conclusion: Our study would indicate that relative to Caucasians, African-American renal transplant recipients are at decreased risk for infectious death and therefore may tolerate the more intensive immuno-suppression that may be necessary to narrow the gap in acute rejection rates between African-Americans and Caucasian renal transplant recipients.