Role of gender and race mismatch and graft failure in patients undergoing liver transplantation
Role of gender and race mismatch and graft failure in patients undergoing liver transplantation
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性别和种族不匹配以及移植失败在肝移植患者中的作用
DOI：
10.1053/jlts.2002.33457
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发表时间：
2002
影响因子：
4.6
通讯作者：
C. Tolleris
中科院分区：
文献类型：
--
作者：
V. Rustgi;G. Mariño;M. Halpern;L. Johnson;W. O. Umana;C. Tolleris
以前的数据表明，男性受体的女性肝脏移植失败的风险增加，在非白人受体原位肝移植。回顾了1992年至2000年的联合器官共享网络（United Network for Organ Sharing）记录，其中至少有一次随访。使用比例风险回归对这些数据进行分析，控制随访时间、年龄、性别、种族、合并症数量、移植时的功能状态和状态1指定。单独分析比较白人和黑人之间的移植，以及男性和女性受体的匹配与不匹配移植。结果显示，与性别匹配的移植（n = 18，522）相比，性别不匹配的患者（n = 13，992）移植失败的可能性更高（分别为12.2%和11.3%，P = 0.013）。在控制上述潜在混杂因素后，发现性别不匹配的患者移植失败的可能性增加6.9%（P = 0.042）。接受男性器官的女性受体移植失败的风险没有显著变化（11.5%; P = 0.368）。接受女性器官的男性受者的结局更差（12.9%; P = .0003）。按种族匹配（白色与白色或非白色与非白色; n = 21，818）的供体患者的移植失败率分别为11.6%和11.9%，在不匹配的患者（n = 10，697）中，差异不显著（P = 0.33）。控制潜在混杂因素的多变量回归分析证实，这种差异不显著（P = .21）。研究发现，黑人供体和白色受体之间的不匹配会增加肝移植失败的风险（27.4%，P = < .0001），与性别、合并症数量和移植时的功能状态无关。
Previous data have suggested an increased risk of graft failure in male recipients of female livers, and in nonwhite recipients of orthotopic liver transplantation. United Network for Organ Sharing records of liver transplantations from 1992 through 2000 with at least one follow‐up visit were reviewed. Analysis of these data was performed with proportional hazards regression, controlling for follow‐up time, age, gender, ethnicity, number of comorbidities, functional status at time of transplant, and status 1 designation. Separate analyses comparing transplants among whites and blacks only and matched versus mismatched transplants for male and female recipients were performed. The results revealed that gender‐mismatched patients (n = 13,992) had a higher likelihood of graft failure when compared with gender matched transplants (n = 18,522) (12.2% versus 11.3% respectively, P = .013). After controlling for the above potential confounders, gender‐mismatched patients were found to have a 6.9% increase in likelihood of graft failure, (P = .042). Female recipients receiving male organs had no significant change in the risk of graft failure (11.5%; P = .368). A worse outcome was found in male recipients receiving female organs (12.9%; P = .0003). Graft failure rate among patients with donors matched by race (white to white or nonwhite to nonwhite; n = 21,818) was 11.6% versus 11.9%, and among unmatched patients (n = 10,697), the difference was not significant (P = .33). Multivariate regression analysis controlling for potential confounders confirmed that this difference was not significant (P = .21). Mismatch between black donors and white recipients was found to increase the risk of liver graft failure (27.4%, P = < .0001), independently of gender, number of comorbidities, and functional status at time of transplant.