The differential effect of race among pediatric kidney transplant recipients with focal segmental glomerulosclerosis
The differential effect of race among pediatric kidney transplant recipients with focal segmental glomerulosclerosis
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DOI：
10.1053/j.ajkd.2004.03.017
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发表时间：
2004-06-01
影响因子：
13.2
通讯作者：
Gipson, DS
中科院分区：
文献类型：
--
作者：
Huang, K;Ferris, ME;Gipson, DS
背景资料：鉴于种族对自体肾局灶节段性肾小球硬化（FSGS）进展、移植肾FSGS复发和同种异体移植物来源的不同影响，作者进行了本研究，以评价种族和同种异体移植物来源对FSGS的影响。研究方法：本研究使用了来自器官共享联合网络登记处的1987年至1997年期间8，065名儿童肾移植受者（n=620 FSGS）的数据。通过种族和同种异体移植物来源的分层分析，可以独立评估FSGS对移植存活率的影响。结果如下：在黑人儿童中，FSGS和非FSGS患者的移植物存活率在受者年龄、复发疾病、移植物来源、零抗原错配和急性排斥反应调整后无差异（风险比[HR]，1.15; 95%置信区间[95%CI]，0.93 - 1.42; P=0.22）。在非黑人儿童中，多变量分析显示，FSGS儿童的同种异体移植物衰竭风险是其他终末期肾病（ESRD）原因的1.31倍（95%CI，1.04 - 1.64; P=0.02）。尽管非黑人FSGS患儿存在疾病复发的影响，但与最低风险组（非黑人、非FSGS、活体供者）相比，活体供者移植失败的风险（HR，1.51; 95%CI，1.08 - 2.10）低于尸体供者（HR，1.80; 95%CI，1.32 - 2.44）。结论：FSGS对儿童移植肾存活率的影响在不同种族之间存在差异。与其他原因的终末期肾病相比，非黑人FSGS儿童的同种异体移植物存活率更低。在非黑人的FSGS儿童中，活体供者移植比尸体移植具有更好的同种异体移植物存活率。
Background: Given the differential effect of race on focal segmental glomerulosclerosis (FSGS) progression in native kidneys, recurrence of FSGS in the transplanted kidney, and allograft source, the authors conducted this study to evaluate the influence of FSGS by race and allograft source. Methods: Data from 8,065 pediatric renal transplant recipients (n=620 FSGS) between 1987 and 1997 from the United Network for Organ Sharing registry were used for this study. Stratified analysis by race and allograft source allowed independent assessment of the effect of FSGS on transplant survival. Results: Among black children, allograft survival was not different between FSGS and non-FSGS patients adjusted for recipient age, recurrent disease, allograft source, zero antigen mismatch, and acute rejection (hazard ratio [HR], 1.15; 95% confidence interval [95% CI], 0.93 to 1.42; P=0.22). Among nonblack children, the risk of allograft failure in children with FSGS was 1.31 times higher than other causes of end-stage renal disease (ESRD) in multivariate analysis (95% CI, 1.04 to 1.64; P=0.02). Despite the impact of disease recurrence in the nonblack children with FSGS, the risk of graft failure was less for living donor recipients (HR, 1.51; 95% CI, 1.08 to 2.10) than for cadaveric recipients (HR, 1.80; 95% CI, 1.32 to 2.44) compared with the lowest risk group (nonblack, non-FSGS, living donor). Conclusion: The effect of FSGS on renal allograft survival in children differs between racial groups. Children of nonblack races with FSGS have a worse allograft survival rate compared with other causes of ESRD. Within nonblack children with FSGS, living donor transplants convey a better allograft survival than cadaveric transplants.