Meier-Kriesche Herwig-Ulf, Ojo Akinlolu O, Leichtman Alan B, Punch Jeffrey D, Hanson Julie A, Cibrik Diane M, Kaplan Bruce
Departments of Medicine and Surgery, University of Michigan, Ann Arbor, Michigan.
J Am Soc Nephrol. 2000 Dec;11(12):2366-2370. doi: 10.1681/ASN.V11122366.
African American renal transplant recipients have poorer graft survival. A study using the United States Renal Data Registry documented an improvement in graft survival for patients who took mycophenolate mofetil (MMF) compared with azathioprine (AZA). This analysis did not address the impact of MMF on African American renal transplant recipients. The present study aimed to quantify potential beneficial effects of MMF therapy on long-term renal allograft survival in African Americans. With the use of the United States Renal Data Registry, all adult Caucasian and African American patients who had received a primary renal transplant between 1988 and 1997 were analyzed by Kaplan-Meier analysis and Cox proportional hazard models. Primary study end points were death with a functioning graft and graft failure censored for death. A total of 57,926 patients were studied. For African Americans, 3-yr patient survival was 96.3 versus 93.2% (P<0.001) for MMF and AZA, respectively. Three-yr death-censored graft survival for African Americans was 85.8 versus 75.1% (P<0.001) for MMF and AZA, respectively. For Caucasians, 3-yr patient survival was 97.3 versus 93.2% for MMF and AZA, respectively. Three-yr death-censored graft survival for Caucasians was 90.1 versus 86.4% (P<0.001) for MMF and AZA, respectively. By multivariate analysis, MMF was associated with a significant reduction in the relative risk for all study end points in African Americans. MMF therapy is associated with both improved patient and death-censored graft survival in African American renal transplant recipients. This benefit is comparable to the benefit of MMF in Caucasian renal transplant recipients.
非裔美国肾移植受者的移植物存活率较低。一项利用美国肾脏数据登记处的研究表明，与硫唑嘌呤（AZA）相比，服用霉酚酸酯（MMF）的患者移植物存活率有所提高。该分析未涉及MMF对非裔美国肾移植受者的影响。本研究旨在量化MMF治疗对非裔美国人长期肾移植存活的潜在有益作用。利用美国肾脏数据登记处，对1988年至1997年间接受初次肾移植的所有成年白种人和非裔美国患者进行了Kaplan-Meier分析和Cox比例风险模型分析。主要研究终点为移植肾功能正常时的死亡和因死亡而截尾的移植失败。共研究了57926例患者。对于非裔美国人，MMF组和AZA组的3年患者存活率分别为96.3%和93.2%（P<0.001）。非裔美国人3年死亡截尾的移植物存活率，MMF组和AZA组分别为85.8%和75.1%（P<0.001）。对于白种人，MMF组和AZA组的3年患者存活率分别为97.3%和93.2%。白种人3年死亡截尾的移植物存活率，MMF组和AZA组分别为90.1%和86.4%（P<0.001）。通过多变量分析，MMF与非裔美国人所有研究终点的相对风险显著降低相关。MMF治疗与非裔美国肾移植受者患者存活率和死亡截尾的移植物存活率提高均相关。这种益处与MMF对白种人肾移植受者的益处相当。
