Racial and Ethnic Disparities in Kidney Transplant Access Within a Theoretical Context of Medical Eligibility
Racial and Ethnic Disparities in Kidney Transplant Access Within a Theoretical Context of Medical Eligibility
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DOI：
10.1097/tp.0000000000002962
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发表时间：
2020-07-01
期刊：
影响因子：
6.2
通讯作者：
Johansen, Kirsten L.
中科院分区：
文献类型：
--
作者：
Ku, Elaine;Lee, Brian K.;Johansen, Kirsten L.
背景与非西班牙裔白人（NHW）相比，非西班牙裔黑人（NHB）和西班牙裔患者接受肾移植的机会较低。我们研究了影响移植资格的合并症患病率的差异是否会导致接受移植的差异。方法.根据美国肾脏数据系统，我们对2005年至2014年期间开始透析的986019名成人进行了回顾性研究。我们按人种/种族比较了可能影响移植资格的合并症的患病率。我们在这个总体队列和一个非常健康的子队列中按人种/种族检查了首次移植的时间，该子队列没有可能成为移植禁忌症的疾病。结果在平均2.3年的随访期间，共进行了64892例移植。在透析开始时，NHB和西班牙裔的移植医学障碍患病率低于NHW，包括年龄>70岁（NHB为26%，NHW为47%）和恶性肿瘤（西班牙裔为4%，NHW为10%）。在终末期肾病后的第一年，NHB的移植机会低65%（95%CI，0.33-0.37），西班牙裔低43%（95%CI，0.54-0.62），但到第4年，西班牙裔或NHB之间的移植机会无统计学显著差异（与NHW相比）。在我们的非常健康的队列中，在获得移植方面的种族和民族差异在NHB患者中持续到5年，在西班牙裔患者中持续到4年。结论.医疗资格的差异似乎不能解释接受肾移植的种族/民族差异，可能掩盖了目前不公平的实际程度。
Background. Non-Hispanic black (NHB) and Hispanic patients have lower access to kidney transplantation compared to non-Hispanic whites (NHWs). We examined whether differences in the prevalence of comorbidities that affect eligibility for transplant contribute to disparities in receipt of transplantation. Methods. We performed a retrospective study of 986 019 adults who started dialysis between 2005 and 2014, according to the United States Renal Data System. We compared prevalence of comorbidities that could influence transplant eligibility by race/ethnicity. We examined time to first transplant by race/ethnicity in this overall cohort and in a very healthy sub-cohort without conditions that could be contraindications to transplantation. Results. During 2.3 years of mean follow-up, 64 892 transplants occurred. NHBs and Hispanics had a lower prevalence of medical barriers to transplantation at the time of dialysis initiation than NHWs, including age >70 years (26% in NHB versus 47% in NHW) and malignancy (4% in Hispanics versus 10% in NHWs). Access to transplant was 65% lower (95% CI, 0.33-0.37) in NHBs and 43% lower (95% CI, 0.54-0.62) in Hispanics (versus NHWs) in the first year after end-stage renal disease, but by Year 4, access to transplantation was not statistically significantly different between Hispanics or NHBs (versus NHWs). In our very healthy cohort, racial and ethnic disparities in access to transplantation persisted up to Year 5 in NHBs and Year 4 in Hispanics after end-stage renal disease onset. Conclusions. Differences in medical eligibility do not appear to explain racial/ethnic disparities in receipt of kidney transplantation and may mask the actual magnitude of the inequities that are present.