Department of Surgery, Division of Organ Transplantation, Institute for Healthcare Studies, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA.
Semin Nephrol. 2010 Jan;30(1):81-9. doi: 10.1016/j.semnephrol.2009.10.009.
Sociocultural and socioeconomic disparities in graft survival, graft function, and patient survival in adult kidney transplant recipients are reviewed. Studies consistently document worse outcomes for black patients, patients with low income, and patients with less education, whereas better outcomes are reported in Hispanic and Asian kidney transplant recipients. However, the distinct roles of racial/ethnic versus socioeconomic factors remain unclear. Attention to potential pathways contributing to disparities has been limited to immunologic and nonimmunologic factors, for which the mechanisms have yet to be fully illuminated. Interventions to reduce disparities have focused on modifying immunosuppressant regimens. Modifying access to care and health care funding policies for immunosuppressive medication coverage also are discussed. The implementation of culturally sensitive approaches to the care of transplant candidates and recipients is promising. Future research is needed to examine the mechanisms contributing to disparities in graft survival and ultimately to intervene effectively.
本文综述了成人肾移植受者中移植物存活率、移植物功能和患者存活率的社会文化和社会经济差异。研究一致表明，黑人患者、收入低的患者和受教育程度低的患者的预后较差，而西班牙裔和亚洲肾移植受者的预后较好。然而，种族/民族与社会经济因素的不同作用仍不清楚。对于导致差异的潜在途径的关注仅限于免疫和非免疫因素，而这些机制尚未完全阐明。减少差异的干预措施侧重于改变免疫抑制剂方案。还讨论了修改获得医疗服务和医疗保健资金政策以覆盖免疫抑制药物的问题。采用对移植候选人和受者护理具有文化敏感性的方法具有广阔的前景。需要开展未来的研究来检验导致移植物存活率差异的机制，并最终有效地进行干预。
