Racial disparities in renal allograft survival: A public health issue?
Racial disparities in renal allograft survival: A public health issue?
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DOI：
10.1016/j.jamcollsurg.2007.01.024
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发表时间：
2007-05-01
影响因子：
5.2
通讯作者：
Diethelm, Arnold G.
中科院分区：
文献类型：
--
作者：
Eckhoff, Devin E.;Young, Carlton J.;Diethelm, Arnold G.
背景技术背景：肾移植结局的种族差异已被记录为非洲裔美国人与非非洲裔美国人相比，移植物存活率较差。这些差异归因于多种因素，包括免疫高反应性、社会经济状况、依从性、HLA配型和获得护理。本研究的目的是检查免疫和非免疫的风险因素，为同种异体移植物丢失的目标，确定有针对性的战略，以改善结果AfricanAmerican.Study设计：我们回顾性分析了所有主要死亡供体成人肾移植（n = 2,453）在我们的中心1987年5月至2004年12月。分析包括受者和供者特征、HLA分型和免疫抑制方案对移植结果的影响。使用标准Kaplan-Meier精算技术分析数据，并使用非参数和参数方法进行探索。在危险功能域进行多变量分析，以确定特定的危险因素与移植loss.Results：1年移植物的生存率在整个研究期间大大提高了受体，3年移植物的生存率也有所改善。风险因素分析按同种异体移植物类型和特定时间段显示。免疫移植物丢失（急性排斥反应）的风险在早期最为突出。在晚期阶段，免疫风险持续存在（慢性排斥反应），但复发性疾病，移植物质量，和收件人的合并症有越来越大的role.CONCLUSIONS：免疫抑制方案的进展，在早期和晚期（恒定）阶段，在所有时代的同种异体移植物存活，但改善长期的结果，非洲裔美国人继续落后于非非洲裔美国人。随着时间的推移，非裔美国人和非裔美国人之间肾移植物丢失的差异表明，除了免疫风险之外，非免疫变量的影响，如移植前透析时间，糖尿病和医疗保健的获得，可能是关键问题。
BACKGROUND: Racial disparities in renal transplantation outcomes have been documented with inferior allograft survival among African Americans compared with non-African Americans. These differences have been attributed to a variety of factors, including immunologic hyperresponsiveness, socioeconomic status, compliance, HLA matching, and access to care. The purpose of this study was to examine both immunologic and nonimmunologic risk factors for allograft loss with a goal of defining targeted strategies to improve outcomes among African Americans.STUDY DESIGN: We retrospectively analyzed all primary deceased-donor adult renal transplants (n = 2,453) at our center between May 1987 and December 2004. Analysis included the impact of recipient and donor characteristics, HLA typing, and immunosuppressive regimen on graft outcomes. Data were analyzed using standard Kaplan-Meier actuarial techniques and were explored with nonparametric and parametric methods. Multivariable analyses in the hazard-function domain were done to identify specific risk factors associated with graft loss.RESULTS: The 1-year allograft survival in recipients improved substantially throughout the study period, and 3-year allograft survival also improved. Risk factor analyses are shown by type of allograft and according to specific time periods. Risk of immunologic graft loss (acute rejection) was most prominent during the early phase. During late-phase, immunologic risk persists (chronic rejection), but recurrent disease, graft quality, and recipient's comorbidities have an increasingly greater role.CONCLUSIONS: Advances in immunosuppression regimens have contributed to allograft survival in both early and late (constant) phases throughout all eras, but improvement in longterm outcomes for African Americans continues to lag behind non-African Americans. The disparity in renal allograft loss between African Americans and non-African Americans over time indicates that beyond immunologic risk, the impact of nonimmunologic variables, such as time on dialysis pretransplantation, diabetes, and access to medical care, can be key issues.