Division of Nephrology, Department of Medicine, University of Virginia Medical Center, Charlottesville, VA, USA.
Clin Transplant. 2012 Jan-Feb;26(1):82-6. doi: 10.1111/j.1399-0012.2011.01398.x. Epub 2011 Jan 28.
Previous studies have shown an inverse association between pre-transplant dialysis exposure and post-kidney transplant outcomes. Socioeconomic and allocation factors, in contrast to medical factors, play a greater role in dialysis exposure among minorities, and medical causes for delay may impact post-transplant outcomes. This study sought to test whether minorities behaved similarly to Caucasians with regard to the effect of duration of dialysis on post-transplant outcomes. All primary deceased donor kidney transplants between 1997 and 2004 (n = 54,162) were analyzed from the Organ Procurement and Transplant Network database and were categorized as either Caucasian or minority. Adjusted patient and graft survivals were determined in each subgroup based on the duration of pre-transplant dialysis. Caucasians recipients show a clear stepwise increase in risk of graft failure and death with increasing duration of dialysis. The risk of graft failure among minorities increased less without a clear stepwise pattern. The risk of death, however, showed a U-shaped risk profile with the highest risk of death among preemptive transplants and recipients with more than five yr of dialysis. The disparate effect of dialysis on minorities suggests that a selection bias and not a biologic effect may explain the association between dialysis duration and outcomes after kidney transplantation previously reported.
先前的研究表明，移植前透析暴露与肾移植后结果呈负相关。与医疗因素相比，社会经济和分配因素在少数族裔的透析暴露中起着更大的作用，而延迟的医疗原因可能会影响移植后的结果。本研究旨在测试在透析时间对移植后结果的影响方面，少数族裔是否与白种人表现出相似的行为。对 1997 年至 2004 年之间的所有主要的已故供体肾移植（n=54162）进行了分析，这些移植都来自器官采购和移植网络数据库，被分为白种人或少数族裔。根据移植前透析的持续时间，在每个亚组中确定了调整后的患者和移植物存活率。白种人接受者的移植物失败和死亡风险随着透析时间的增加而明显呈阶梯式上升。少数族裔的移植物失败风险增加不明显，没有明确的阶梯式模式。然而，死亡风险呈 U 形风险曲线，预防性移植和透析时间超过 5 年的接受者的死亡风险最高。透析对少数族裔的不同影响表明，可能是选择偏差而不是生物学效应解释了先前报告的透析时间与肾移植后结果之间的关联。
