Callender C O, Cherikh W S, Traverso P, Hernandez A, Oyetunji T, Chang D
Howard University Hospital, 2041 Georgia Ave, NW, Suite 3100, Washington, DC 20060, USA.
Transplant Proc. 2009 Dec;41(10):4125-30. doi: 10.1016/j.transproceed.2009.06.182.
Previous multivariate analysis performed between April 1, 1994, and December 31, 2000 from the Organ Procurement Transplant Network/United Network for Organ Sharing (OPTN/UNOS) database has shown that kidneys from black donors were associated with lower graft survival. We compared graft and patient survival of different kidney donor-to-recipient ethnic combinations to see if this result still holds on a recent cohort of US kidney transplants.
We included 72,495 recipients of deceased and living donor kidney alone transplants from 2001 to 2005. A multivariate Cox regression method was used to analyze the effect of donor-recipient ethnicity on graft and patient survival within 5 years of transplant, and to adjust for the effect of other donor, recipient, and transplant characteristics. Results are presented as hazard ratios (HR) with the 95% confidence limit (CL) and P values.
Adjusted HRs of donor-recipient patient survival were: white to white (1); and white to black (1.22; P = .001). Graft survival HRs were black to black (1.40; P <.001); black to white (1.35; P <.001); black to Hispanic (0.87; P = .18); and black to Asian (0.69; P =.05).
Black donor kidneys are associated with significantly lower graft survival when transplanted into whites or blacks and are only associated with lower patient survival when these kidneys are transplanted into white recipients. The graft and patient survival rates for Asian and Latino/Hispanic recipients, however, were not affected by donor ethnicity. This analysis underscores the need for research to better understand the reasons for these disparities and how to improve the posttransplant graft survival rates of black kidney recipients.
1994年4月1日至2000年12月31日期间，器官获取与移植网络/器官共享联合网络（OPTN/UNOS）数据库进行的既往多变量分析显示，黑人供者的肾脏与较低的移植肾存活率相关。我们比较了不同肾供者与受者种族组合的移植肾和患者存活率，以观察这一结果在近期美国肾移植队列中是否仍然成立。
我们纳入了2001年至2005年单独接受 deceased 和活体供者肾脏移植的72495名受者。采用多变量Cox回归方法分析供者-受者种族对移植后5年内移植肾和患者存活率的影响，并对其他供者、受者和移植特征的影响进行校正。结果以风险比（HR）、95%置信区间（CL）和P值表示。
供者-受者患者存活率的校正HR分别为：白人供者至白人受者（1）；白人供者至黑人受者（1.22；P = 0.001）。移植肾存活率HR分别为：黑人供者至黑人受者（1.40；P < 0.001）；黑人供者至白人受者（1.35；P < 0.001）；黑人供者至西班牙裔受者（0.87；P = 0.18）；黑人供者至亚裔受者（0.69；P = 0.05）。
黑人供者的肾脏移植给白人或黑人时，与显著较低的移植肾存活率相关，而仅在移植给白人受者时与较低的患者存活率相关。然而，亚裔和拉丁裔/西班牙裔受者的移植肾和患者存活率不受供者种族的影响。该分析强调需要进行研究，以更好地理解这些差异的原因以及如何提高黑人肾移植受者移植后的移植肾存活率。
