A Comparison of Racial Differences in Renal Transplant Outcomes in Brazil & the United States.  
Ross B. Isaacs, Steven L. Nock, Ricardo Sesso. University of Virginia, Charlottesville, VA; Escola 
Paulista de Medicina, San Paulo, Brazil. 

Important racial differences exist for minorities undergoing renal transplantation in the US. The causes for outcome differences are poorly understood but include both genetic and social factors. We previously 
presented data demonstrating the Relative Risk (RR) of graft loss in African Americans (AA) persisted despite controlling for rejection or genotypic haploidentical matching, suggesting social influences may play 
an important role. To test this hypothesis we compared outcome results in the US with outcome results in Brazil where more universal healthcare exists thus minimizing the effect of socioeconomic variables on outcomes. All LRD’s performed in the US between 1988 & 1996 were recorded by UNOS and assessed by Cox hazards univariate analysis according to race. Racial groups in the US included AA, Caucasian (Cauc), and Other (Hispanic, Native American, Asian, and ”Other“). LRD’s were analyzed because they excluded the effects of ischemia, preservation injury and donor disease. We compared our outcomes to all LRD’s performed in Brazil from 1987-1997 by race; racial groups in Brazil included AA, Caucasian & mullatos. 
14,617 patients underwent LRD’s in the US. 73% were Cauc, 13% AA & 15% other. The RR of graft loss in AA was 1.77 (p<.01) compared to Cauc. 4,633 patients received LRD’s in Brazil 75% were Caucasian, 8% AA & 17% mullato. The RR of graft loss for AA vs Cauc in Brazil was 1.53 (p<.01). 
CONCLUSION: Important racial differences exist between AA and Cauc undergoing LRD renal transplantation both in Brazil and the US, however, the differences in Brazil are 25% less than the US. 
Further studies are needed to better understand this survival advantage for AA in Brazil compared to the US and to test whether these are related to socioeconomic or genetic factors. 

Poster Session: Predictors of Allograft Outcome (9:30 AM-5:00 PM) 

Presentation Date: Friday, November 5, 1999, Time: 9:30AM, Room: Halls B and C