Gaston R S, Hudson S L, Deierhoi M H, Barber W H, Laskow D A, Julian B A, Curtis J J, Barger B O, Shroyer T W, Diethelm A G
Department of Medicine, University of Alabama, Birmingham 35294.
Transplantation. 1992 Jan;53(1):103-9. doi: 10.1097/00007890-199201000-00020.
Black recipients of cadaveric kidneys have been shown to have a lower rate of allograft survival than whites. Data were reviewed from 642 primary cadaveric transplants: results in 276 patients (163 white and 113 black) (group 1) who had received triple therapy (azathioprine-CsA-prednisone, 1985-87) were compared with those in 366 patients (180 white and 186 black) (group 2) receiving quadruple immunosuppression (MALG-azathioprine-CsA-prednisone, 1987-90). Blacks in group 2 had better patient (97% vs. 91%, P = 0.03) and graft (77% vs. 55%, P = 0.0002) survival at 1 year than in group 1. There was no difference in these parameters among whites in either group. Racial differences in graft survival noted in group 1 disappeared in group 2. While HLA BDR matching improved in group 2 patients (P = 0.0001), whites received better matched kidneys than blacks in both groups (P = 0.001). HLA matching was associated with improved graft survival only in white recipients of 4 BDR-matched kidneys. In group 1, more blacks than whites had at least one episode of acute rejection (76% vs. 57%, P = 0.001); blacks also lost more grafts to acute and chronic rejection. In group 2, there were no racial differences in the number of rejection episodes or immunologic graft losses. Of 14 potential variables examined by parametric analysis, only quadruple therapy significantly reduced risk of graft loss in blacks. Quadruple immunosuppression improved primary cadaveric renal allograft survival in black recipients, abrogating previously noted racial differences.
已表明接受尸体肾移植的黑人同种异体移植存活率低于白人。回顾了642例初次尸体肾移植的数据：将276例接受三联疗法（硫唑嘌呤 - 环孢素 - 泼尼松，1985 - 1987年）的患者（163例白人，113例黑人）（第1组）的结果与366例接受四联免疫抑制（MALG - 硫唑嘌呤 - 环孢素 - 泼尼松，1987 - 1990年）的患者（180例白人，186例黑人）（第2组）的结果进行比较。第2组中的黑人在1年时的患者存活率（97%对91%，P = 0.03）和移植物存活率（77%对55%，P = 0.0002）均优于第1组。两组中的白人在这些参数上没有差异。第1组中观察到的移植物存活率的种族差异在第2组中消失。虽然第2组患者的HLA BDR匹配有所改善（P = 0.0001），但两组中白人接受的肾脏匹配程度均优于黑人（P = 0.001）。HLA匹配仅在接受4个BDR匹配肾脏的白人受者中与移植物存活率提高相关。在第1组中，发生至少一次急性排斥反应的黑人比白人多（76%对57%，P = 0.001）；黑人因急性和慢性排斥反应失去的移植物也更多。在第2组中，排斥反应发作次数或免疫性移植物丢失方面没有种族差异。在通过参数分析检查的14个潜在变量中，只有四联疗法显著降低了黑人移植物丢失的风险。四联免疫抑制改善了黑人受者初次尸体肾同种异体移植的存活率，消除了先前观察到的种族差异。
