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Decreased effect of immunosuppression on immunocompetence in African–Americans after kidney and liver transplantation
Author(s) -
Nagashima Naoki,
Watanabe Takuji,
Nakamura Michio,
Shalabi Ahmed,
Burdick James F
Publication year - 2001
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1034/j.1399-0012.2001.150207.x
Subject(s) - immunosuppression , medicine , immunocompetence , transplantation , tacrolimus , kidney transplantation , liver transplantation , immunology , lymphocyte , kidney , immune system , gastroenterology
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.