Patzer Rachel E, Mohan Sumit, Kutner Nancy, McClellan William M, Amaral Sandra
1] Department of Surgery, Division of Transplantation, Emory University School of Medicine, Emory University, Atlanta, Georgia, USA [2] Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.
Department of Medicine, Division of Nephrology, Columbia University Medical Center, New York, New York, USA.
Kidney Int. 2015 Mar;87(3):584-92. doi: 10.1038/ki.2014.345. Epub 2014 Oct 22.
This study was undertaken to describe the association of patient race/ethnicity and renal allograft survival among the national cohort of pediatric renal allograft recipients. Additionally, we determined whether racial and ethnic differences in graft survival exist among individuals living in low- or high-poverty neighborhoods and those with private or public insurance. Among 6216 incident, pediatric end-stage renal disease patients in the United States Renal Data System (kidney transplant from 2000 through September, 2011), 14.4% experienced graft failure, with a median follow-up time of 4.5 years. After controlling for multiple covariates, black race, but not Hispanic ethnicity, was significantly associated with a higher rate of graft failure for both deceased and living donor transplant recipients. Disparities were particularly stark by 5 years post transplant, when black living donor transplant recipients experienced only 63.0% graft survival compared with 82.8 and 80.8% for Hispanics and whites, respectively. These disparities persisted among high- and low-poverty neighborhoods and among both privately and publicly insured patients. Notably profound declines in both deceased and living donor graft survival rates for black, compared with white and Hispanic, children preceded the 3-year mark when transplant Medicare eligibility ends. Further research is needed to identify the unique barriers to long-term graft success among black pediatric transplant recipients.
本研究旨在描述美国儿科肾移植受者全国队列中患者种族/族裔与肾移植存活率之间的关联。此外，我们还确定了生活在高贫困或低贫困社区以及拥有私人或公共保险的个体之间在移植存活率上是否存在种族和族裔差异。在美国肾脏数据系统中6216例新发的儿科终末期肾病患者（2000年至2011年9月期间接受肾移植）中，14.4%经历了移植失败，中位随访时间为4.5年。在控制了多个协变量后，黑人种族而非西班牙裔与已故和活体供体移植受者的移植失败率较高显著相关。移植后5年时，差异尤为明显，此时黑人活体供体移植受者的移植存活率仅为63.0%，而西班牙裔和白人分别为82.8%和80.8%。这些差异在高贫困和低贫困社区以及私人和公共保险患者中均持续存在。值得注意的是，在移植医疗保险资格结束的3年期限之前，黑人儿童与白人及西班牙裔儿童相比，已故和活体供体移植存活率均显著下降。需要进一步研究以确定黑人儿科移植受者长期移植成功的独特障碍。
