Department of Medicine, Section of Nephrology, St Boniface Hospital, University of Manitoba, 409 Tache Avenue, Winnipeg R2H 2A6, Canada.
BMC Nephrol. 2013 Jan 14;14:11. doi: 10.1186/1471-2369-14-11.
Previous studies have demonstrated Aboriginals are less likely to receive a renal transplant in comparison to Caucasians however whether this applies to the entire population or specific subsets remains unclear. We examined the effect of age on renal transplantation in Aboriginals.
Data on 30,688 dialysis (Aboriginal 2,361, Caucasian 28, 327) patients obtained between Jan. 2000 and Dec. 2009 were included in the final analysis. Racial status was self-reported. Cox proportional hazards, the Fine and Grey sub-distribution method and Poisson regression were used to determine the association between race, age and transplantation.
In comparison to Caucasians, Aboriginals were less likely to receive a renal transplant (Adjusted HR 0.66 95% CI 0.57-0.77, P < 0.0001) however after stratification by age and treating death as a competing outcome, the effect was more predominant in younger Aboriginals (Age 18-40: 20.6% aboriginals vs. 48.3% Caucasians transplanted; aHR 0.50(0.39-0.61), p < 0.0001, Age 41-50: 10.2% aboriginals vs. 33.9% Caucasians transplanted; aHR 0.46(0.32-0.64), p = 0.005, Age 51-60: 8.2% aboriginals vs. 19.5% Caucasians transplanted; aHR0.65(0.49-0.88), p = 0.01, Age >60: 2.7% aboriginals vs. 2.6% Caucasians transplanted; aHR 1.21(0.76-1.91), P = 0.4, Age X race interaction p < 0.0001). Both living and deceased donor transplants were lower in Aboriginals under the age of 60 compared to Caucasians.
Younger Aboriginals are less likely to receive a renal transplant compared to their Caucasian counterparts, even after adjustment for comorbidity. Determination of the reasons behind these discrepancies and interventions specifically targeting the Aboriginal population are warranted.
先前的研究表明，与白人相比，原住民接受肾移植的可能性较低，但这是否适用于整个人群或特定亚群尚不清楚。我们研究了年龄对原住民肾移植的影响。
最终分析纳入了 2000 年 1 月至 2009 年 12 月期间获得的 30688 名透析患者（原住民 2361 名，白种人 28327 名）的数据。种族状况为自我报告。使用 Cox 比例风险、Fine 和 Grey 亚分布法和泊松回归来确定种族、年龄和移植之间的关联。
与白人相比，原住民接受肾移植的可能性较低（调整后的 HR 0.66，95%CI 0.57-0.77，P < 0.0001），但按年龄分层并将死亡视为竞争结果后，这种影响在年轻的原住民中更为明显（年龄 18-40 岁：20.6%的原住民与 48.3%的白人接受移植；aHR 0.50（0.39-0.61），P < 0.0001，年龄 41-50 岁：10.2%的原住民与 33.9%的白人接受移植；aHR 0.46（0.32-0.64），P = 0.005，年龄 51-60 岁：8.2%的原住民与 19.5%的白人接受移植；aHR 0.65（0.49-0.88），P = 0.01，年龄 >60 岁：2.7%的原住民与 2.6%的白人接受移植；aHR 1.21（0.76-1.91），P = 0.4，年龄与种族的交互作用 P < 0.0001）。与白人相比，60 岁以下的原住民接受活体和已故供体移植的可能性较低。
与白人相比，年轻的原住民接受肾移植的可能性较低，即使在调整了合并症后也是如此。需要确定这些差异背后的原因，并针对原住民群体进行具体干预。
