University Hospital of Wales, Cardiff, UK.
Am J Transplant. 2010 Jul;10(7):1605-12. doi: 10.1111/j.1600-6143.2010.03041.x. Epub 2010 Feb 25.
Socio-economic deprivation is an important determinant of poor health and is associated with a higher incidence of end-stage renal disease, higher mortality for dialysis patients and lower chance of being listed for transplantation. The influence of deprivation on outcomes following renal transplantation has not previously been reported in the United Kingdom. The Welsh Index of Multiple Deprivation was used to assess the influence of socio-economic deprivation on outcomes for 621 consecutive renal transplant recipients from a single centre in the United Kingdom transplanted between 1997 and 2005. Outcomes measured were rate of acute rejection and graft survival. Patients from the most deprived areas were significantly more likely to experience an episode of acute rejection requiring treatment (36% vs. 27%, p=0.01) and increasing overall deprivation correlated with increasing rates of rejection (p=0.03). Income deprivation was significantly and independently associated with graft survival (HR 1.484, p=0.046). Among patients who experienced acute rejection 5-year graft survival was 79% for those from the most deprived areas compared with 90% for patients from the least deprived areas (p = 0.018). Overall socio-economic deprivation is associated with higher rate of acute rejection following renal transplantation and income deprivation is a significant and independent predictor of graft survival.
社会经济剥夺是健康状况不佳的一个重要决定因素，与终末期肾病的发病率较高、透析患者的死亡率较高以及移植机会较低有关。在英国，以前没有报道过社会经济剥夺对肾移植后结局的影响。威尔士多重剥夺指数用于评估英国一个单一中心的 621 名连续肾移植受者的社会经济剥夺对 1997 年至 2005 年间移植结果的影响。测量的结果是急性排斥反应的发生率和移植物存活率。来自最贫困地区的患者发生需要治疗的急性排斥反应的可能性明显更高（36%比 27%，p=0.01），而且总体剥夺程度与排斥反应率的增加呈正相关（p=0.03）。收入剥夺与移植物存活率显著相关（HR 1.484，p=0.046）。在经历急性排斥反应的患者中，来自最贫困地区的患者 5 年移植物存活率为 79%，而来自最贫困地区的患者为 90%（p=0.018）。总体社会经济剥夺与肾移植后急性排斥反应发生率较高有关，而收入剥夺是移植物存活率的一个显著和独立的预测因素。
