Racial differences in the development of de-novo donor-specific antibodies and treated antibody-mediated rejection after heart transplantation
Racial differences in the development of de-novo donor-specific antibodies and treated antibody-mediated rejection after heart transplantation
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DOI：
10.1016/j.healun.2017.11.003
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发表时间：
2018-04-01
影响因子：
8.9
通讯作者：
Morris, Alanna A.
中科院分区：
文献类型：
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作者：
Cole, Robert Townsend;Gandhi, Jonathan;Morris, Alanna A.
背景：尽管心脏移植后的结果有所改善，但与非黑人接受者相比，黑人接受者的生存率较差。这种不同结果的根源在很大程度上仍然未知。我们假设，从头产生供者特异性抗体（dnDSA）的倾向和随后的抗体介导的排斥反应（AMR）可能是心脏移植后次优结果的种族差异的原因。在本研究中，我们旨在确定 dnDSA 和 AMR 在移植后结果种族差异中的作用。 方法：本研究是对 137 名从埃默里大学医院出院的心脏移植受者（81% 男性，48% 黑人）进行的单中心回顾性分析。出于我们分析的目的，患者被分为黑人和非黑人。 Kaplan-Meier 和 Cox 回归分析用于评估种族与所选结果之间的关联。主要成果是 dnDSA 的开发。次要结局包括治疗后的 AMR 和全因移植物功能障碍或死亡的综合结果。 结果：经过 3.7 年的随访，39 名 (28.5%) 患者出现 dnDSA，19 名 (13.8%) 患者接受了 AMR 治疗。在多变量模型中，与非黑人种族相比，黑人种族发生 dnDSA 的风险较高（风险比 [HR] 3.65，95% 置信区间 [CI] 1.54 至 8.65，p = 0.003），且治疗 AMR 的风险较高（HR 4.86，95% CI 1.26 至 18.72，p = 0.021）。在单变量分析中，黑人种族还与全因移植物功能障碍或死亡的较高风险相关（HR 2.10，95% CI 1.02至4.30，p = 0.044）。然而，在纳入 dnDSA 的多变量模型中，黑人种族不再是一个重要的风险因素。只有 dnDSA 的发生与全因移植物功能障碍或死亡显着相关（HR 4.85，95% CI 1.89 至 12.44，p = 0.001）。 结论：黑人移植受者发生 dnDSA 和接受治疗的 AMR 的风险较高，这可能是心脏移植后结果存在种族差异的原因。 (C) 2018 年国际心肺移植学会。版权所有。
BACKGROUND: Despite improvements in outcomes after heart transplantation, black recipients have worse survival compared with non-black recipients. The source of such disparate outcomes remains largely unknown. We hypothesize that a propensity to generate de-novo donor-specific antibodies (dnDSA) and subsequent antibody-mediated rejection (AMR) may account for racial differences in suboptimal outcomes after heart transplant. In this study we aimed to determine the role of dnDSA and AMR in racial disparities in post-transplant outcomes.METHODS: This study was a single-center, retrospective analysis of 137 heart transplant recipients (81% male, 48% black) discharged from Emory University Hospital. Patients were classified as black vs nonblack for the purpose of our analysis. Kaplan-Meier and Cox regression analyses were used to evaluate the association between race and selected outcomes. The primary outcome was the development of dnDSA. Secondary outcomes included treated AMR and a composite of all-cause graft dysfunction or death.RESULTS: After 3.7 years of follow-up, 39 (28.5%) patients developed dnDSA and 19 (13.8%) were treated for AMR. In multivariable models, black race was associated with a higher risk of developing dnDSA (hazard ratio [HR] 3.65, 95% confidence interval [CI] 1.54 to 8.65, p = 0.003) and a higher risk of treated AMR (HR 4.86, 95% CI 1.26 to 18.72, p = 0.021) compared with non-black race. Black race was also associated with a higher risk of all-cause graft dysfunction or death in univariate analyses (HR 2.10, 95% CI 1.02 to 4.30, p = 0.044). However, in a multivariable model incorporating dnDSA, black race was no longer a significant risk factor. Only dnDSA development was significantly associated with all-cause graft dysfunction or death (HR 4.85, 95% CI 1.89 to 12.44, p = 0.001).CONCLUSION: Black ransplant recipients are at higher risk for the development of dnDSA and treated AMR, which may account for racial disparities in outcomes after heart transplantation. (C) 2018 International Society for Heart and Lung Transplantation. All rights reserved.