RACIAL-DIFFERENCES IN THE SURVIVAL OF CADAVERIC RENAL-ALLOGRAFTS - OVERRIDING EFFECTS OF HLA MATCHING AND SOCIOECONOMIC-FACTORS
RACIAL-DIFFERENCES IN THE SURVIVAL OF CADAVERIC RENAL-ALLOGRAFTS - OVERRIDING EFFECTS OF HLA MATCHING AND SOCIOECONOMIC-FACTORS
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DOI：
10.1056/nejm199209173271203
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发表时间：
1992-09-17
影响因子：
158.5
通讯作者：
RAJU, SS
中科院分区：
文献类型：
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作者：
BUTKUS, DE;MEYDRECH, EF;RAJU, SS
背景尽管黑人和白色受者的一年移植物存活率相似，但黑人受者的尸体肾移植物长期存活率低于白人受者。我们试图确定是什么因素导致了这种不稳定性。我们研究了100例连续的初次尸体肾移植受者（57例为黑人，43例为白色），移植后至少1年（平均40个月）;所有受者均接受了相同的免疫抑制治疗。我们评估了终末期肾病的病因和持续时间、移植前输血次数、年龄、HLA-A、B和DR抗原匹配、供者种族、保险范围和依从性的差异，以评估其对两组移植物存活率的影响。黑人患者1年后的同种异体移植物存活率显著低于白色患者（P = 0.025）。根据单因素分析，只有受体的移植年龄，HLA抗原不匹配的数量，保险范围的类型，移植转诊的来源，以及依从性的程度与移植物存活率显着相关。所有降低移植物存活率的变量的频率在黑人中更高。根据比例风险分析，导致移植物存活率较低的唯一因素是移植时年龄小于30岁（相对风险，2.3; 95%置信区间，1.3至4.6），所有六种HLA抗原的错配与三种或更少的错配相比（相对风险，5.6; 95%置信区间，3.3至9.6），以及医疗补助或医疗保险的覆盖范围（相对风险，2.2; 95%置信区间，1.5至3.2）。种族没有额外的影响。不服从在黑人中更常见（16%对2%），可以替代模型中的保险状态。当黑人和白色移植受者的免疫抑制相当时，明显的种族相关的尸体肾移植物长期存活差异似乎与其他不利影响移植物存活的因素有关，特别是HLA配型差和不利的社会经济因素。
Background. The long-term survival of cadaveric renal allografts is lower in black recipients than in white recipients, although the one-year graft survival is similar in these racial groups. We sought to determine what factors account for this disparity.Methods. We studied 100 consecutive recipients of primary cadaveric renal allografts (57 were black and 43 white) at least 1 year after transplantation (mean, 40 months); all had received identical immunosuppressive therapy. We evaluated differences in the cause and duration of end-stage renal disease, the number of pretransplantation transfusions, age, matching for HLA-A, B, and DR antigens, race of the donor, insurance coverage, and compliance to assess their effect on graft survival in both groups.Results. Allograft survival after one year was significantly lower in black than in white patients (P = 0.025). According to univariate analysis, only the recipient's age at transplantation, the number of mismatches for HLA antigens, the type of insurance coverage, the source of referral for transplantation, and the degree of compliance correlated significantly with the rate of graft survival. The frequency of all variables that reduced graft survival was higher among the blacks. According to proportional-hazards analysis, the only factors contributing to a lower rate of graft survival were age of less than 30 years at transplantation (relative risk, 2.3; 95 percent confidence interval, 1.3 to 4.6), mismatches for all six HLA antigens as compared with three or fewer mismatches (relative risk, 5.6; 95 percent confidence interval, 3.3 to 9.6), and coverage by Medicaid or Medicare (relative risk, 2.2; 95 percent confidence interval, 1.5 to 3.2). Race had no additional effect. Noncompliance was more frequent among blacks (16 percent vs. 2 percent) and could substitute for insurance status in the model.Conclusions. When immunosuppression is equivalent in black and white transplant recipients, apparently race-related differences in the long-term survival of renal cadaveric allografts appear to be related to other factors that affect graft survival unfavorably, notably poor HLA matching and unfavorable socioeconomic factors.