Recipient race is associated with renal allograft survival. Rates of allograft loss are approximately 1.5 to 2-fold higher among African-Americans compared with other racial groups. It is not clear whether genetic, immunologic, or other non-biological factors (e.g., racial differences in access to care) are responsible for these findings. We propose to explore the issue of race-specific allograft loss by comparing differences in early allograft outcomes (delayed graft function and acute rejection) and late allograft outcomes (5-year graft survival, graft failure defined as return to dialysis or death with a functioning graft) among African-Americans in Veterans' Health Administration (VHA) and non-VHA settings. While biological differences are present across practice sites, access to care is more uniform within the VHA. We will examine the associations of demographic, clinical, socioeconomic, dialysis and transplant related variables with outcomes. Analyses using conventional regression analyses (e.g., logistic and proportional hazards regression) and the marginal structural model will be performed. Given the scarcity of organs for transplantation, it is of paramount importance to ensure that graft dysfunction does not result from differences in access to care. This study will help define the contribution of access to care in racial differences in renal transplant outcomes.
