Nephrology, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20889, USA.
Transplantation. 2013 Jun 27;95(12):1471-8. doi: 10.1097/TP.0b013e318292520e.
An analysis of income and racial/ethnic disparities on renal transplant outcomes in recipients with lupus nephritis (LN) has not been reported. We analyzed the United States Renal Data System database to assess the impact of these disparities on graft loss and death in the LN and non-LN cohorts.
We identified 4214 patients with LN as the cause of end-stage renal disease in a retrospective cohort of 150,118 patients first transplanted from January 1, 1995 to July 1, 2006. We merged data on median household income from the United States Census based on the ZIP code.
In multivariate Cox regression analyses, African-Americans (AF) recipients with LN (vs. non-AF) had an increased risk of graft loss (adjusted hazard ratio [AHR], 1.39; 95% confidence interval [CI], 1.21-1.60) and death (AHR, 1.33; 95% CI, 1.09-1.63). Furthermore, there were significant associations of lower-income quintiles with higher risk for graft loss and death among AF with LN. In comparison, among non-AF recipients with LN, income levels did not predict risk for transplant outcomes. The racial disparity for both graft loss and death outcomes among AF with LN was greater than among AF without LN (AHR, 1.32; 95% CI, 1.29-1.36 for graft loss and AHR, 1.02; 95% CI, 0.99-1.05 for death).
AF kidney transplant recipients with LN were at increased risk for graft loss and death compared with non-AF. Income levels were associated with the risk of graft loss and death in AF but not in non-AF recipients with LN.
目前尚未有分析报告收入和种族/民族差异对狼疮性肾炎（LN）接受者肾移植结局的影响。我们分析了美国肾脏数据系统数据库，以评估这些差异对 LN 和非 LN 队列中移植物丢失和死亡的影响。
我们在 1995 年 1 月 1 日至 2006 年 7 月 1 日期间首次接受移植的 150118 例患者的回顾性队列中，确定了 4214 例 LN 患者作为终末期肾病的病因。我们根据邮政编码合并了来自美国人口普查的中位数家庭收入数据。
在多变量 Cox 回归分析中，LN 的非裔美国人（AF）（与非 AF）受者移植物丢失（调整后的危险比 [AHR]，1.39；95%置信区间 [CI]，1.21-1.60）和死亡（AHR，1.33；95%CI，1.09-1.63）的风险增加。此外，在 LN 的 AF 中，收入较低的五分位数与移植物丢失和死亡的风险增加之间存在显著关联。相比之下，在 LN 的非 AF 受者中，收入水平并不能预测移植结局的风险。在 LN 的 AF 中，与非 LN 的 AF 相比，种族差异在移植物丢失和死亡结局方面更大（AHR，1.32；95%CI，1.29-1.36 用于移植物丢失和 AHR，1.02；95%CI，0.99-1.05 用于死亡）。
与非 AF 相比，LN 的 AF 肾移植受者移植物丢失和死亡的风险增加。收入水平与 AF 但与 LN 的非 AF 受者的移植物丢失和死亡风险相关。
