Racial Disparities in Kidney Transplant Outcomes Among Black and White Recipients Treated with Cyclosporine and mTOR Inhibitors.

OBJECTIVE

Racial disparities in kidney transplant outcomes remain a persistent challenge despite advances in immunosuppression. This study examined short- and intermediate-term graft outcomes among Black and White recipients receiving cyclosporine plus mTOR inhibitor based regimens.

METHODS

Using the TriNetX Global Collaborative Network, we identified adult kidney transplant recipients, stratified cohorts by race (Black vs. White), matched 1:1 on demographics, comorbidities, and concomitant medications. Outcomes included transplant rejection, graft failure, and all-cause mortality at one year and between one to three years post-transplant. Analyses included risk differences, hazard ratios (HR), and Kaplan-Meier survival estimates.

RESULTS

Matched cohorts included 305 Black and 305 White recipients. At one year, Black patients experienced significantly higher rejection (23.6% vs. 16.1%; HR 1.50, 95% CI 1.04-2.16) and graft failure (22.6% vs. 15.1%; HR 1.54, 95% CI 1.06-2.24), mortality was similar (6.9% vs. 8.9%, p = 0.367). Between one and three years, disparities persisted: rejection occurred in 21.3% of Black vs. 13.8% of White recipients (HR 1.69, 95% CI 1.15-2.49), and failure in 20.7% vs. 12.5% (HR 1.79, 95% CI 1.20-2.68). Mortality remained nonsignificant (10.2% vs. 8.2%, p = 0.400).

CONCLUSION

Despite matched clinical profiles and immunosuppressive regimens, Black kidney transplant recipients experienced persistently higher rates of rejection and graft failure. These findings highlight persistent disparities in transplant outcomes and the need for equity-driven interventions to improve equity in graft survival.