Racial disparities in access to HLA-matched unrelated donor transplants: a prospective 1312-patient analysis
Racial disparities in access to HLA-matched unrelated donor transplants: a prospective 1312-patient analysis
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DOI：
10.1182/bloodadvances.2018028662
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发表时间：
2019-04-09
期刊：
影响因子：
7.5
通讯作者：
Politikos, Ioannis
中科院分区：
文献类型：
--
作者：
Barker, Juliet N.;Boughan, Kirsten;Politikos, Ioannis
8/8 HLA等位基因匹配的无关供体（URD）的可用性是少数民族和种族的障碍。我们前瞻性地评估了2005年至2017年期间接受8/8个HLA等位基因匹配的URD或7/8个URD或脐带血（CB）移植的患者。如果有匹配的URD，则优先考虑。在1312例患者中，723例（55%）接受8/8 URD，219例（17%）接受7/8 URD，319例（24%）接受CB，51例（4%）未接受7/8或8/8 URD或CB移植物。欧洲人比非欧洲人更有可能接受8/8 URD移植（67% vs 33%），不接受URD或CB移植的可能性更低（1% vs 9%）。南欧人接受8/8次URD移植（41%）的比率与亚洲人（34%）和白色西班牙裔人（35%）相似;非洲人接受8/8次URD移植的可能性最小（18%）。CB和7/8个URD将移植通路扩展到所有组。在742例近期患者中，早期观察到的8/8例URD获得的组间明显种族差异持续存在，8/8例URD移植的百分比仅略有增加。在最近的7/8例非洲患者中，46%接受了CB移植，14%没有7/8或8/8 URD或CB移植。增加登记规模并没有解决URD获取的种族差异，这强调了替代移植来源的重要性。
Availability of 8/8 HLA-allele matched unrelated donors (URDs) is a barrier for ethnic and racial minorities. We prospectively evaluated receipt of 8/8 HLA-allele matched URD or either 7/8 URD or cord blood (CB) transplants by patient ancestry from 2005 to 2017. Matched URDs were given priority if they were available. Of 1312 patients, 723 (55%) received 8/8 URD, 219 (17%) 7/8 URD, 319 (24%) CB, and 51 (4%) had no 7/8 or 8/8 URD or CB graft. Europeans were more likely to receive an 8/8 URD transplant than non-Europeans (67% vs 33%) and less likely to have no URD or CB graft (1% vs 9%). Southern Europeans received 8/8 URD transplants (41%) at rates similar to those of Asians (34%) and white Hispanics (35%); Africans were the least likely (18%) to undergo 8/8 URD transplantation. CB and 7/8 URDs extended transplant access to all groups. In 742 recent patients, marked racial disparity in 8/8 URD access between groups observed in earlier years persisted with only a modest increase in the percentage of 8/8 URD transplants. Of 78 recent African patients, 46% received a CB transplant and 14% had no 7/8 or 8/8 URD or CB graft. Increasing registry size has not resolved the racial disparity in URD access, which emphasizes the importance of alternative graft sources.