1 Department of Nephrology, Royal Melbourne Hospital, Melbourne, Australia. 2 Australia and New Zealand Dialysis and Transplant Registry, Adelaide, South Australia, Australia. 3 Discipline of Medicine, University of Adelaide, Adelaide, South Australia, Australia. 4 Menzies School of Health Research, Darwin, Northern Territory, Australia.
Transplantation. 2016 Oct;100(10):2168-76. doi: 10.1097/TP.0000000000001007.
Indigenous Australians experience significantly worse graft and patient outcomes after kidney transplantation compared with nonindigenous Australians. It is unclear whether rural versus urban residential location might contribute to this.
All adult patients from the Australia and New Zealand Dialysis and Transplant Registry who received a kidney transplant in Australia between January 1, 2000, and December 31, 2012, were investigated. Patients' residential location was classified as urban (major city + inner regional) or rural (outer regional - very remote) using the Australian Bureau of Statistics Remoteness Area Classification.
Of 7826 kidney transplant recipients, 271 (3%) were indigenous. Sixty-three percent of indigenous Australians lived in rural locations compared with 10% of nonindigenous Australians (P < 0.001). In adjusted analyses, the hazards ratio for graft loss for Indigenous compared with non-Indigenous race was 1.59 (95% confidence interval [95% CI], 1.01-2.50; P = 0.046). Residential location was not associated with graft survival. Both indigenous race and residential location influenced patient survival, with an adjusted hazards ratio for death of 1.94 (95% CI, 1.23-3.05; P = 0.004) comparing indigenous with nonindigenous and 1.26 (95% CI, 1.01-1.58; P = 0.043) comparing rural with urban recipients. Five-year graft and patient survivals were 70% (95% CI, 60%-78%) and 69% (95% CI, 61%-76%) in rural indigenous recipients compared with 91% (95% CI, 90%-92%) and 92% (95% CI, 91%-93%) in urban nonindigenous recipients.
Indigenous kidney transplant recipients experience worse patient and graft survival compared with nonindigenous recipients, whereas rural residential location is associated with patient but not graft survival. Of all groups, indigenous recipients residing in rural locations experienced the lowest 5-year graft and patient survivals.
与非土著澳大利亚人相比，土著澳大利亚人在接受肾移植后，移植物和患者的预后明显更差。目前尚不清楚农村与城市居住地点是否对此有影响。
本研究调查了 2000 年 1 月 1 日至 2012 年 12 月 31 日期间在澳大利亚接受肾移植的所有澳大利亚和新西兰透析和移植登记处的成年患者。使用澳大利亚统计局偏远地区分类法将患者的居住地点分为城市（主要城市+内区域）或农村（外区域-非常偏远）。
在 7826 例接受肾移植的患者中，有 271 例（3%）为土著人。与非土著澳大利亚人（10%）相比，63%的土著澳大利亚人居住在农村地区（P < 0.001）。在调整后的分析中，与非土著种族相比，土著种族的移植物丢失风险比为 1.59（95%置信区间[95%CI]，1.01-2.50；P = 0.046）。居住地点与移植物存活率无关。土著种族和居住地点都影响患者存活率，与非土著相比，调整后的死亡风险比为 1.94（95%CI，1.23-3.05；P = 0.004），与农村相比，调整后的死亡风险比为 1.26（95%CI，1.01-1.58；P = 0.043）。农村土著受者的 5 年移植物和患者存活率分别为 70%（95%CI，60%-78%）和 69%（95%CI，61%-76%），而城市非土著受者分别为 91%（95%CI，90%-92%）和 92%（95%CI，91%-93%）。
与非土著受者相比，土著肾移植受者的患者和移植物存活率更差，而农村居住地点与患者存活率有关，但与移植物存活率无关。在所有组中，居住在农村地区的土著受者的 5 年移植物和患者存活率最低。
