Impact of Race-Adjusted Glomerular Filtration Rate Estimation on Eligibility for Simultaneous Liver-Kidney Transplantation.
Impact of Race-Adjusted Glomerular Filtration Rate Estimation on Eligibility for Simultaneous Liver-Kidney Transplantation.
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DOI：
10.1002/lt.26310
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发表时间：
2022-06
期刊：
影响因子：
--
通讯作者：
Mahmud N
中科院分区：
文献类型：
--
作者：
Panchal S;Serper M;Bittermann T;Asrani SK;Goldberg DS;Mahmud N
在常用的公式中，估计的肾小球滤过率（eGFR）对黑人进行了调整。这对同时进行肝肾移植（SLKT）有潜在的影响，因为合格标准依赖于eGFR。我们对联合器官共享网络（UNOS） 2002年2月28日至2019年3月31日期间的国家移植登记数据进行了回顾性研究，以评估如果从两个突出的eGFR方程（MDRD-4和CKD-EPI）中去除种族调整，将被重新分类为符合SLKT标准（根据现行政策定义）的黑人患者的比例。在研究期间列出的7937名黑人移植患者中，我们发现3.6%的患者将被重新分类为符合慢性肾脏疾病（CKD）相关SLKT的资格，剔除MDRD-4的种族调整，3.0%的患者被重新分类为CKD- epi；这代表SLKT候选性分别增加了23.7%和18.7%。重分类对女性的影响大于男性（例如，MDRD-4对女性的影响为4.5%比3.0%,p<0.05）。在一项探索性分析中，与SLKT相比，符合种族未调整eGFR方程的SLKT标准的患者更有可能接受单独肝移植（LTA）。大约2%的重分类患者在LTA术后一年内需要肾移植，而未重分类患者的这一比例为0.3%。总之，eGFR方程中的种族调整可能会影响3-4%的LTA黑人患者的SLKT候选性。大约2%的患者被重新分类为符合SLKT标准，需要在lta后进行短期肾移植。这些数据支持开发新的算法来估计GFR，以促进公平。
Estimated glomerular filtration rate (eGFR) is adjusted for Black race in commonly used formulas. This has potential implications for access to simultaneous liver-kidney transplant (SLKT), as qualifying criteria rely on eGFR. We performed a retrospective study of United Network for Organ Sharing (UNOS) national transplant registry data between 2/28/2002 and 3/31/2019 to evaluate the proportion of Black patients who would be reclassified as meeting SLKT criteria (as defined per current policies) if race adjustment were removed from two prominent eGFR equations (MDRD-4 and CKD-EPI). Of the 7,937 Black patients listed for transplant during the study period, we found that 3.6% would have been reclassified as qualifying for chronic kidney disease (CKD)-related SLKT with removal of race adjustment for MDRD-4, and 3.0% for CKD-EPI; this represented 23.7% and 18.7% increases in SLKT candidacy, respectively. Reclassification impacted women more than men (e.g. 4.5% vs. 3.0% by MDRD-4, p<0.05). In an exploratory analysis, patients meeting SLKT criteria by race unadjusted eGFR equations were significantly more likely to receive liver transplantation alone (LTA) as compared to SLKT. Approximately 2% of reclassified patients required kidney transplantation within one year of LTA, versus 0.3% of non-reclassified patients. In conclusion, race adjustment in eGFR equations may impact SLKT candidacy for 3–4% of Black patients listed for LTA overall. Approximately 2% of patients reclassified as meeting SLKT criteria require short-term post-LTA kidney transplantation. These data argue for developing novel algorithms for GFR estimation free of race to promote equity.
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影响因子：
6.2
作者：
Allen AM;Heimbach JK;Larson JJ;Mara KC;Kim WR;Kamath PS;Therneau TM
通讯作者：
Therneau TM
影响因子：
13.8
作者：
Zelnick LR;Leca N;Young B;Bansal N
通讯作者：
Bansal N
DOI：
10.1002/lt.24750
发表时间：
2017-05
期刊：
Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society
影响因子：
--
作者：
Carey EJ;Lai JC;Wang CW;Dasarathy S;Lobach I;Montano-Loza AJ;Dunn MA;Fitness, Life Enhancement, and Exercise in Liver Transplantation Consortium
通讯作者：
Fitness, Life Enhancement, and Exercise in Liver Transplantation Consortium
影响因子：
13.5
作者：
Mindikoglu, Ayse L.;Dowling, Thomas C.;Weir, Matthew R.;Seliger, Stephen L.;Christenson, Robert H.;Magder, Laurence S.
通讯作者：
Magder, Laurence S.
影响因子：
13.8
作者：
Bragg-Gresham J;Zhang X;Le D;Heung M;Shahinian V;Morgenstern H;Saran R
通讯作者：
Saran R