Taber David J, Douglass Kevin, Srinivas Titte, McGillicuddy John W, Bratton Charles F, Chavin Kenneth D, Baliga Prabhakar K, Egede Leonard E
Division of Transplant Surgery, Medical University of South Carolina, Charleston, S.C., USA.
Am J Nephrol. 2014;40(1):19-28. doi: 10.1159/000363393. Epub 2014 Jun 25.
There is continued and significant debate regarding the salient etiologies associated with graft loss and racial disparities in kidney transplant recipients.
This was a longitudinal cohort study of all adult kidney transplant recipients, comparing patients with early graft loss (<5 years) to those with graft longevity (surviving graft with at least 5 years of follow-up) across racial cohorts [African-American (AA) and non-AA] to discern risk factors.
524 patients were included, 55% AA, 151 with early graft loss (29%) and 373 with graft longevity (71%). Consistent within both races, early graft loss was significantly associated with disability income [adjusted odds ratio (AOR) 2.2, 95% CI 1.1-4.5], Kidney Donor Risk Index (AOR 3.2, 1.4-7.5), rehospitalization (AOR 2.1, 1.0-4.4) and acute rejection (AOR 4.4, 1.7-11.6). Unique risk factors in AAs included Medicare-only insurance (AOR 8.0, 2.3-28) and BK infection (AOR 5.6, 1.3-25). Unique protective factors in AAs included cardiovascular risk factor control: AAs with a mean systolic blood pressure <150 mm Hg had 80% lower risk of early graft loss (AOR 0.2, 0.1-0.7), while low-density lipoprotein <100 mg/dl (AOR 0.4, 0.2-0.8), triglycerides <150 mg/dl (AOR 0.4, 0.2-1.0) and hemoglobin A1C <7% (AOR 0.2, 0.1-0.6) were also protective against early graft loss in AA, but not in non-AA recipients.
AA recipients have a number of unique risk factors for early graft loss, suggesting that controlling cardiovascular comorbidities may be an important mechanism to reduce racial disparities in kidney transplantation.
关于肾移植受者移植物丢失的主要病因以及种族差异，一直存在持续且激烈的争论。
这是一项针对所有成年肾移植受者的纵向队列研究，比较了早期移植物丢失（<5年）的患者与移植物长期存活（随访至少5年且移植物存活）的患者在不同种族队列[非裔美国人（AA）和非AA]中的情况，以识别风险因素。
共纳入524例患者，其中55%为非裔美国人，151例早期移植物丢失（29%），373例移植物长期存活（71%）。在两个种族中，早期移植物丢失均与残疾收入[调整优势比（AOR）2.2，95%置信区间1.1 - 4.5]、肾脏供体风险指数（AOR 3.2，1.4 - 7.5）、再次住院（AOR 2.1，1.0 - 4.4）和急性排斥反应（AOR 4.4，1.7 - 11.6）显著相关。非裔美国人的独特风险因素包括仅参加医疗保险（AOR 8.0，2.3 - 28）和BK感染（AOR 5.6，1.3 - 25）。非裔美国人的独特保护因素包括心血管危险因素控制：平均收缩压<150 mmHg的非裔美国人早期移植物丢失风险降低80%（AOR 0.2，0.1 - 0.7），而低密度脂蛋白<100 mg/dl（AOR 0.4，0.2 - 0.8）、甘油三酯<150 mg/dl（AOR 0.4，0.2 - 1.0）和糖化血红蛋白<7%（AOR 0.2，0.1 - 0.6）对非裔美国人的早期移植物丢失也有保护作用，但对非非裔美国人受者无此作用。
非裔美国受者存在一些导致早期移植物丢失的独特风险因素，这表明控制心血管合并症可能是减少肾移植种族差异的重要机制。
