Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.
Gastroenterology. 2010 Jun;138(7):2341-7. doi: 10.1053/j.gastro.2010.02.008. Epub 2010 Feb 19.
BACKGROUND & AIMS: Donor race has been proposed to predict graft failure after liver transplantation. We evaluated the extent to which the center where the transplantation surgery was performed and other potential confounding factors might account for the observed association between donor race and graft failure.
We analyzed data from the Organ Procurement and Transplantation Network (January 2003-December 2005) for adult patients undergoing primary liver transplantation in the United States. We examined the association between graft failure and the donor races of African American (AA), Caucasian, Asian/Pacific Islander (API), or those classified as other.
Of 10,874 livers that were donated for transplantation, 7631 came from Caucasians, 1579 from AAs, 243 from APIs, and 1421 from others. After 36 months of follow-up evaluation, 2687 grafts failed. Without any adjustments, AA donors (hazard ratio [HR], 1.11; 95% confidence interval [CI], 1.00-1.24), API donors (HR, 1.41; 95% CI, 1.12-1.77), and other donors (HR, 1.16; 95% CI, 1.04-1.29) were associated with graft failure. After stratification by center and adjustments for age, height, and hepatitis B core antibody status of donors as well as serum creatinine and hepatitis C status of recipients, donor race was no longer statistically significant for AA (HR, 1.06; 95% CI, 0.95-1.20) and API (HR, 1.15; 95% CI, 0.89-1.49) donors. However, livers donated from members of other race still had an increased risk of graft failure (HR, 1.19; 95% CI, 1.05-1.35), although the effect was not uniform across donor-recipient pairs.
Donor race is not a uniform predictor of graft failure and should not be construed as an indicator of donor quality.
供体种族被认为是肝移植后移植物失功的预测因素。我们评估了手术中心以及其他潜在混杂因素在多大程度上可以解释供体种族与移植物失功之间的观察到的关联。
我们分析了美国器官获取与移植网络（2003 年 1 月至 2005 年 12 月）的数据，纳入了在美国接受首次肝移植的成年患者。我们检测了移植物失功与供体的非洲裔美国人（AA）、白种人、亚洲/太平洋岛民（API）或其他种族之间的关系。
在 10874 例可供移植的肝脏中，7631 例来自白种人，1579 例来自 AA，243 例来自 API，1421 例来自其他种族。在 36 个月的随访评估中，2687 例移植物失功。未经任何调整，AA 供体（风险比[HR]，1.11；95%置信区间[CI]，1.00-1.24）、API 供体（HR，1.41；95% CI，1.12-1.77）和其他供体（HR，1.16；95% CI，1.04-1.29）与移植物失功相关。按中心分层，并调整供体的年龄、身高和乙型肝炎核心抗体状态以及受体的血清肌酐和丙型肝炎状态后，AA（HR，1.06；95% CI，0.95-1.20）和 API（HR，1.15；95% CI，0.89-1.49）供体的种族与移植物失功不再具有统计学意义。然而，来自其他种族的供体的肝脏仍然有更高的移植物失功风险（HR，1.19；95% CI，1.05-1.35），尽管这种影响在供体-受体对之间并不均匀。
供体种族不是移植物失功的统一预测因素，不应被视为供体质量的指标。
