Decreased effect of immunosuppression on immunocompetence in African-Americans after kidney and liver transplantation

被引:13
作者
Nagashima, N [1 ]
Watanabe, T [1 ]
Nakamura, M [1 ]
Shalabi, A [1 ]
Burdick, JF [1 ]
机构
[1] Johns Hopkins Med Inst, Baltimore, MD 21287 USA
关键词
African-American; cyclosporine; immunocompetence; immunosuppression; kidney transplantation; liver transplantation; lymphocyte activation; mycophenolate mofetil; tacrolimus;
D O I
10.1034/j.1399-0012.2001.150207.x
中图分类号
R61 [外科手术学];
学科分类号
摘要
Several studies indicate that the poorer outcomes for African-Americans after transplantation may be due to decreased effectiveness of immunosuppressive agents. Using an in vitro test of immunocompetence (IMC), we measured the effects of immunosuppression on African-American, compared with Caucasian, kidney or liver transplantation recipients. The IMC result was the highest of three mixed lymphocyte culture responses using validated stimulator cell pools. A total of 293 tests were done in Caucasians and 144 in African-Americans. Overall, the IMC for African-Americans was 38, compared with 19 for Caucasians (p < 0.01). This decreased effect of immunosuppression (higher IMC) was the same for liver as for kidney transplant recipients, occurred at the 2-3-yr interval, and was largely in patients of tacrolimus (FK506), with a strong but not significant trend in cyclosporine (CYA) recipients. The two groups were on the same nominal immunosuppression and FK506 and CYA levels were not different. We conclude that African-Americans retain more immune responsiveness on equivalent dose immunosuppression, notable particularly in years 2-3 after transplantation when earlier graft loss occurs in this group.
引用
收藏
页码:111 / 115
页数:5
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