Division of Nephrology, Department of Medicine, University of Virginia, Charlottesville, VA 22908, USA.
Clin Transplant. 2011 Jan-Feb;25(1):69-76. doi: 10.1111/j.1399-0012.2010.01223.x.
African American (AA) renal transplant recipients have poorer graft survival compared to other racial and ethic groups. This study was undertaken to determine whether pre-transplant factors and events occurring in the first six months post-transplant were predictive of the poorer long-term outcomes in AA recipients. To control for kidney quality, a paired analysis of deceased donor kidneys in which one donor kidney was transplanted into an adult AA recipient and the other was transplanted into an adult Caucasian was undertaken. Cox proportional hazard modeling was used to determine the impact of outcome variables at six months. Outcomes at six months among the paired recipients were very similar for graft and patient survival, and estimated glomerular filtration rate (GFR). Less than 10% of difference in long-term outcomes was explained by differences in the pre-transplant covariates and events in the first six months. Causes of graft failure after six months revealed a two to three times higher rate of chronic allograft nephropathy (CAN) and late acute rejection among AA. In conclusion, early outcomes after kidney transplant did not predict the poor long-term graft survival among AA, and AA recipients appear to be more prone to graft loss because of CAN and late acute rejection.
非裔美国人（AA）肾移植受者的移植物存活率较其他种族和民族群体差。本研究旨在确定移植前因素和移植后前六个月发生的事件是否可预测 AA 受者的长期预后较差。为了控制肾脏质量，对一对接受已故供体肾脏的患者进行了分析，其中一个供体肾脏被移植到成年 AA 受者，另一个被移植到成年白人。使用 Cox 比例风险模型来确定六个月时结局变量的影响。配对受者在六个月时的移植物和患者存活率以及估计肾小球滤过率（GFR）非常相似。在六个月前的移植前协变量和前六个月发生的事件差异仅解释了不到 10%的长期结局差异。六个月后移植物失功的原因表明，AA 患者慢性移植肾肾病（CAN）和晚期急性排斥的发生率高 2-3 倍。总之，肾移植后早期结局并不能预测 AA 患者长期移植物存活率差，AA 受者似乎更容易因 CAN 和晚期急性排斥而导致移植物丢失。
