Dawidson I J, Coorpender L, Fisher D, Helderman H, Hull A, Palmer B, Peters P, Sagalowsky A, Sandor Z F, Toto R
Department of Surgery, University of Texas Southwestern Medical Center, Dallas 75235.
Transplantation. 1990 Jan;49(1):63-7. doi: 10.1097/00007890-199001000-00014.
The influence of race on the outcome of cadaver renal transplantation (CRT) continues to be controversial even in the cyclosporine era. The present study examines the effect of race in 343 adult CRT performed from 1/1/82 through 10/1/88 with regard to the incidence of delayed function (DF), graft survival (GS), and patient survival (PS). Blacks constituted 38% of the patients. A history of nephrosclerosis secondary to hypertension was more common in blacks, with 51% (67/130) vs. 8% (17/213) in whites, while glomerulonephritis and Type 1 diabetes mellitus were more common in whites. There was no significant difference in the number of HLA (A,B,DR) matches or DR mismatches between whites and blacks. With azathioprine immunosuppression DF was more common in blacks than in whites, 54% (14/26) vs. 20% (11/55) respectively (P less than 0.01). The higher incidence of DF in blacks than in whites on Aza was associated with a significantly lower dose of intraoperative albumin, 0.25 g/kg vs. 0.44 g/kg, respectively (P less than 0.01). Of the Aza treated black recipients who had DF, 79% (11/14) had graft loss within three months, significantly worse than 25% (3/12) with graft loss when immediate function was present (P less than 0.005). Currently, all patients receive at least 0.80 g/kg of albumin intraoperatively and CsA quadruple induction therapy. With the current regimen, black and white recipients of primary CRT recipients have a comparable low incidence of DF of 18% and 22%, respectively. However, DF remains high among repeat black or white recipients: 33% (10/30) and 57% (8/14), respectively. The incidence of rejection within 30 days was similar for black and white recipients during the Aza and CsA eras, 62% vs. 75% and 34% vs. 42% respectively. GS and PS at three months for blacks on Aza were 54% and 89%, respectively, reflecting the corresponding high incidence of DF. This compares with 71% and 97% GS and PS for whites on Aza. Blacks and whites receiving CsA had equivalent 1-year GS and PS: 76% and 92%, respectively. We conclude that, in our center during the Aza era, blacks had a higher incidence of DF and lower GS than whites. With our current intraoperative fluid replacement and CsA immunosuppression, the incidence of DF and GS and PS are equivalent in black and white recipients.
即使在环孢素时代，种族对尸体肾移植（CRT）结果的影响仍然存在争议。本研究调查了1982年1月1日至1988年10月1日期间进行的343例成人CRT中，种族对移植肾功能延迟恢复（DF）发生率、移植物存活率（GS）和患者存活率（PS）的影响。黑人占患者总数的38%。黑人中继发于高血压的肾硬化病史更为常见，占51%（67/130），而白人中仅占8%（17/213），而白人中肾小球肾炎和1型糖尿病更为常见。白人和黑人之间的人类白细胞抗原（A、B、DR）匹配数或DR错配数没有显著差异。使用硫唑嘌呤免疫抑制时，黑人发生DF比白人更常见，分别为54%（14/26）和20%（11/55）（P<0.01）。黑人使用硫唑嘌呤时DF发生率高于白人，与术中白蛋白剂量显著较低有关，分别为0.25g/kg和0.44g/kg（P<0.01）。在接受硫唑嘌呤治疗且发生DF的黑人受者中，79%（11/14）在三个月内移植肾丢失，明显差于移植肾功能立即恢复者中25%（3/12）的移植肾丢失率（P<0.005）。目前，所有患者术中至少接受0.80g/kg白蛋白和环孢素四联诱导治疗。采用当前方案时，初次CRT受者中黑人和白人的DF发生率相当低，分别为18%和22%。然而，再次移植的黑人和白人受者中DF发生率仍然很高：分别为33%（10/30）和57%（8/14）。在硫唑嘌呤和环孢素时代，黑人和白人受者在30天内的排斥反应发生率相似，分别为62%对75%和34%对42%。使用硫唑嘌呤时，黑人在三个月时的GS和PS分别为54%和89%，反映出相应的高DF发生率。相比之下，使用硫唑嘌呤的白人GS和PS分别为71%和97%。接受环孢素治疗的黑人和白人1年GS和PS相当：分别为76%和92%。我们得出结论，在硫唑嘌呤时代，我们中心黑人的DF发生率高于白人，GS低于白人。采用我们目前的术中液体替代和环孢素免疫抑制方案，黑人和白人受者的DF、GS和PS发生率相当。
