Black Canadians with kidney transplants fare better than African Americans

WASHINGTON—Black Canadian and American kidney disease patients are less likely to have access to kidney transplants than white kidney disease patients, but only African-Americans have worse health outcomes than whites after a transplant is performed, according to a study appearing in the January 2009 issue of the Journal of the American Society Nephrology.

The results could further open the debate about what has driven the disparities seen only in the United States.

Health disparities among different racial and ethnic groups have been noted for a number of conditions, including kidney disease. African Americans in need of a kidney transplant are less likely to receive one than Caucasians, and even after they do receive a transplant, African Americans experience higher rates of donor kidney failure and death. However, no studies have looked at disparities in health outcomes following kidney transplantation in Canada.

Karen Yeates, MD, of QueensUniversity in Kingston, Ontario, and her colleagues performed such a study by analyzing data from the Canadian national renal replacement therapy registry, which included information on 20,243 dialysis patients (3 percent black and 97 percent white), 5,036 of whom received a kidney transplant during the study.

The investigators found that Black Canadians were significantly less likely than Caucasians to receive a kidney transplant, either from deceased or living donors. This situation mimics that seen in the United States. However, unlike African-Americans, Black Canadians who underwent a kidney transplant experienced no significant health differences compared with Caucasians after their procedure. Their transplanted kidneys survived just as long as kidneys transplanted into Caucasians, and Black Canadians actually survived longer following the surgery compared with Caucasians.

The study's findings raise questions concerning why there are health disparity differences between the two countries, according to Yeates. "Hypotheses behind this difference could be that the better renal transplant outcomes for African-Americans in Canada are due to better access to post-transplant medical care and access to immunosuppressive medications that are more comprehensive than in the United States," she said.

Unlike African-Americans, Black Canadians have free access to pre-dialysis care, kidney transplantation and follow-up care at all kidney transplant centers. Understanding these differences could highlight U.S. policy issues related to access to medications and medical services that need to be improved, according to the study.

"... [A]lthough this study is observation and further study is needed, our results raise potentially important questions about whether better access to health services for African-Americans would improve outcomes following kidney transplantation in this population," the authors wrote.