Section of Nephrology, Department of Medicine, School of Medicine, Tulane University, New Orleans, LA, USA.
Transpl Int. 2011 Mar;24(3):259-65. doi: 10.1111/j.1432-2277.2010.01188.x. Epub 2010 Nov 22.
Undertaking transplantation in highly sensitized African American (AA) patients as transplant recipients represents a unique challenge. We retrospectively compared the outcomes of AA with non-African American (NAA) patients who had panel reactive antibody >80% and received deceased donor (DD) kidneys by virtual crossmatch. Immunosuppressive regimen included basiliximab induction and tacrolimus, mycophenolate acid and steroids maintenance. Among 835 consecutive transplants from 1998 to 2007, 142 (17%) were sensitized patients including 89 (16.6%) AA and 53 (17.7%) NAA patients. The AA group had similar 5-year incidence of acute rejection as NAA group (21.4% vs. 26.4%, P = 0.25). Kaplan-Meier estimated graft survival at 1, 3 and 5 years were 91%, 85% and 82% in AA group, and 94%, 79% and 71% in NAA group (P = 0.08). The death-censored graft survival at 1, 3, and 5 years were 93%, 86% and 84% in AA group, and 96%, 83% and 78% in NAA group (P = 0.11). The 1, 3, and 5 years patient survivals were 93%, 88% and 85% in AA group, and 96%, 96% and 94% in NAA group (P = 0.17). Highly sensitized AA patients could be transplanted with DD kidneys at a similar rate as NAA patients, and they may not have a higher incidence of rejection or an inferior graft survival than NAA patients.
在高度致敏的非裔美国人（AA）患者中进行移植作为移植受者代表着一个独特的挑战。我们回顾性比较了 panel reactive antibody >80%且接受死亡供体（DD）肾脏的 AA 与非非裔美国人（NAA）患者的结果，这些患者通过虚拟交叉匹配。免疫抑制方案包括巴利昔单抗诱导和他克莫司、霉酚酸酯酸和类固醇维持。在 1998 年至 2007 年期间进行的 835 例连续移植中，有 142 例（17%）是致敏患者，包括 89 例（16.6%）AA 和 53 例（17.7%）NAA 患者。AA 组与 NAA 组的急性排斥反应发生率相似（21.4% vs. 26.4%，P = 0.25）。Kaplan-Meier 估计 AA 组 1、3 和 5 年的移植物存活率分别为 91%、85%和 82%，NAA 组分别为 94%、79%和 71%（P = 0.08）。AA 组 1、3 和 5 年的死亡风险调整移植物存活率分别为 93%、86%和 84%，NAA 组分别为 96%、83%和 78%（P = 0.11）。AA 组 1、3 和 5 年的患者存活率分别为 93%、88%和 85%，NAA 组分别为 96%、96%和 94%（P = 0.17）。高度致敏的 AA 患者可以与 NAA 患者以相似的速度接受 DD 肾脏移植，他们的排斥反应发生率或移植物存活率可能不比 NAA 患者差。
