1Division of Nephrology and Hypertension Department of Medicine.
Lupus. 2014 Feb;23(2):151-8. doi: 10.1177/0961203313513819. Epub 2013 Dec 2.
African Americans with lupus who receive kidney transplants have high prevalence of predictors of allograft failure, which can explain their poor outcomes.
Of 1223 African Americans and 1029 Caucasian Americans with lupus who received kidney transplants from deceased donors between 1987 and 2006 with complete records in the UNOS program, 741 pairs were matched in 16 predictors employing a predicted probability of group membership. The primary outcome was allograft failure. Main secondary outcomes were rejection, allograft failure due to rejection, and mortality.
Matched pairs were predominantly women (82%) with a mean age of 39 years. Twenty-four percent of recipients received kidneys from expanded criteria donors. African Americans and Caucasian Americans matched well (p ≥ 0.05): donor age, gender and race; recipient age, gender, education and insurance; dialysis prior to transplant, kidneys from expanded criteria donors, cold ischemia time, history of prior kidney transplant, panel reactive antibodies, human leukocyte antigens mismatch, blood type compatibility, transplant Era, and follow-up time. Contrary to the unmatched cohort with significantly higher allograft failure rate (events per 100 patient-years) in African Americans compared to Caucasian Americans (10.49 vs 6.18, p<0.001), matched pairs had similar allograft failure rates (8.41 vs 7.81, p=0.418). Matched pairs also had similar rates of rejections (9.82 vs 9.39, p=0.602), allograft failure due to rejection (6.19 vs 5.71, p=0.453), and mortality (2.79 vs 3.52, p=0.097).
In lupus recipients of kidney transplants from deceased donors, African American and Caucasian Americans have similar allograft failure rates when predictors are matched between groups.
接受肾移植的非裔美国狼疮患者中，同种异体移植物失功的预测因素高发，这可以解释他们的不良结局。
在 1987 年至 2006 年间，UNOS 计划记录完整的 1223 名非裔美国人和 1029 名白种人狼疮患者接受了来自已故供者的肾移植，通过预测分组概率对 16 个预测因素进行了 741 对匹配。主要结局是同种异体移植物失功。主要次要结局是排斥反应、排斥反应导致的同种异体移植物失功和死亡率。
匹配对主要为女性（82%），平均年龄为 39 岁。24%的受者接受了扩展标准供者的肾脏。非裔美国人和白种人匹配良好（p≥0.05）：供者年龄、性别和种族；受者年龄、性别、教育和保险；移植前透析、扩展标准供者的肾脏、冷缺血时间、既往肾移植史、群体反应性抗体、人类白细胞抗原错配、血型相容性、移植时代和随访时间。与未匹配队列相比，非裔美国人的同种异体移植物失功率（每 100 患者年事件数）显著更高（10.49 比 6.18，p<0.001），但匹配对的同种异体移植物失功率相似（8.41 比 7.81，p=0.418）。匹配对的排斥反应率（9.82 比 9.39，p=0.602）、排斥反应导致的同种异体移植物失功率（6.19 比 5.71，p=0.453）和死亡率（2.79 比 3.52，p=0.097）也相似。
在接受已故供者肾移植的狼疮患者中，当组间匹配预测因素时，非裔美国人和白种人同种异体移植物失功率相似。
