Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA.
Am J Kidney Dis. 2011 Nov;58(5):813-6. doi: 10.1053/j.ajkd.2011.05.023. Epub 2011 Jul 29.
African Americans have lower rates of obtaining a deceased donor kidney transplant (DDKT) compared with their white counterparts. One proposed mechanism is differential HLA distributions between African Americans and whites. In May 2003, the United Network for Organ Sharing/Organ Procurement and Transplantation Network changed kidney allocation policy to eliminate priority based on HLA-B matching in an effort to address this disparity. The objective of this study was to quantify the effect of the change in policy regarding priority points for HLA-B matching.
Observational cohort study.
SETTING & PARTICIPANTS: A cohort of 178,902 patients registered for a DDKT between January 2000 and August 2009.
African Americans versus whites before and after the policy change. Cox models were adjusted for age, sex, diabetes, dialysis type, insurance status, education, panel-reactive antibody level, and blood type.
Adjusted relative rates (aRRs) of deceased donor kidney transplant for African Americans compared with whites.
Time from initial active wait listing to DDKT, censored for living donor kidney transplant and death.
Before the policy change, African Americans had 37% lower rates of DDKT (aRR, 0.63; 95% CI, 0.60-0.65; P < 0.001). After the policy change, African Americans had 23% lower rates of DDKT (aRR, 0.77; 95% CI, 0.76-0.79; P < 0.001). There was a 23% reduction in the disparity between African Americans and whites after the policy change (interaction aRR, 1.23; 95% CI, 1.18-1.29; P < 0.001).
As an observational study, findings could have been affected by residual confounding or other changes in practice patterns.
Racial disparity in rates of DDKT was decreased by the HLA-B policy change, but parity was not achieved. There are unaddressed factors in kidney allocation that lead to continued disparity on the kidney transplant waiting list.
与白人相比，非裔美国人获得已故供体肾移植（DDKT）的比例较低。一个提出的机制是非洲裔美国人和白人之间 HLA 分布的差异。2003 年 5 月，美国器官共享网络/器官获取和移植网络改变了肾脏分配政策，取消了基于 HLA-B 匹配的优先权，以努力解决这一差距。本研究的目的是量化 HLA-B 匹配优先点改变政策的效果。
观察性队列研究。
2000 年 1 月至 2009 年 8 月期间登记接受 DDKT 的 178902 名患者的队列。
政策变更前后的非裔美国人和白人。Cox 模型调整了年龄、性别、糖尿病、透析类型、保险状况、教育程度、面板反应性抗体水平和血型。
与白人相比，非裔美国人接受已故供体肾移植的调整后相对率（aRR）。
从首次主动等待名单到 DDKT 的时间，对活体供肾移植和死亡进行了删失。
在政策变更之前，非裔美国人的 DDKT 率降低了 37%（aRR，0.63；95%CI，0.60-0.65；P<0.001）。政策变更后，非裔美国人的 DDKT 率降低了 23%（aRR，0.77；95%CI，0.76-0.79；P<0.001）。政策变更后，非裔美国人和白人之间的差距缩小了 23%（交互 aRR，1.23；95%CI，1.18-1.29；P<0.001）。
由于这是一项观察性研究，因此研究结果可能受到残余混杂因素或其他实践模式变化的影响。
HLA-B 政策的改变降低了 DDKT 率的种族差异，但并未实现平等。在肾脏分配中，仍存在未解决的因素，导致肾脏移植等待名单上持续存在差异。
