Department of Biostatistics, Kidney Epidemiology and Cost Center, University of Michigan, Ann Arbor, USA.
Am J Transplant. 2011 Aug;11(8):1712-8. doi: 10.1111/j.1600-6143.2011.03606.x. Epub 2011 Jun 14.
In 2003, the US kidney allocation system was changed to eliminate priority for HLA-B similarity. We report outcomes from before and after this change using data from the Scientific Registry of Transplant Recipients (SRTR). Analyses were based on 108 701 solitary deceased donor kidney recipients during the 6 years before and after the policy change. Racial/ethnic distributions of recipients in the two periods were compared (chi-square); graft failures were analyzed using Cox models. In the 6 years before and after the policy change, the overall number of deceased donor transplants rose 23%, with a larger increase for minorities (40%) and a smaller increase for non-Hispanic whites (whites) (8%). The increase in the proportion of transplants for non-whites versus whites was highly significant (p < 0.0001). Two-year graft survival improved for all racial/ethnic groups after implementation of this new policy. Findings confirmed prior SRTR predictions. Following elimination of allocation priority for HLA-B similarity, the deficit in transplantation rates among minorities compared with that for whites was reduced but not eliminated; furthermore, there was no adverse effect on graft survival.
2003 年，美国的肾脏分配系统发生了改变，取消了 HLA-B 相似性的优先级。我们使用来自移植受者科学登记处（SRTR）的数据，报告了这一变化前后的结果。分析基于政策变化前后 6 年期间的 108701 例单独的已故供体肾脏受者。比较了两个时期受者的种族/民族分布（卡方检验）；使用 Cox 模型分析移植物失败。在政策变化前后的 6 年中，已故供体移植的总数增加了 23%，少数族裔（40%）的增幅较大，非西班牙裔白人（白人）的增幅较小（8%）。非白人接受移植的比例相对于白人的增加非常显著（p < 0.0001）。实施这一新政策后，所有种族/民族群体的两年移植物存活率都有所提高。研究结果证实了之前 SRTR 的预测。取消 HLA-B 相似性分配优先级后，与白人相比，少数族裔的移植率不足的情况有所减少，但并未消除；此外，对移植物存活率没有不利影响。
