Purnell Tanjala S, Luo Xun, Kucirka Lauren M, Cooper Lisa A, Crews Deidra C, Massie Allan B, Boulware L Ebony, Segev Dorry L
Division of Transplantation, Department of Surgery, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; and Johns Hopkins Center to Eliminate Cardiovascular Health Disparities,
Division of Transplantation, Department of Surgery.
J Am Soc Nephrol. 2016 Aug;27(8):2511-8. doi: 10.1681/ASN.2015030293. Epub 2016 Feb 4.
Earlier studies reported inferior outcomes among black compared with white kidney transplant (KT) recipients. We examined whether this disparity improved in recent decades. Using the Scientific Registry of Transplant Recipients and Cox regression models, we compared all-cause graft loss among 63,910 black and 145,482 white adults who received a first-time live donor KT (LDKT) or deceased donor KT (DDKT) in 1990-2012. Over this period, 5-year graft loss after DDKT improved from 51.4% to 30.6% for blacks and from 37.3% to 25.0% for whites; 5-year graft loss after LDKT improved from 37.4% to 22.2% for blacks and from 20.8% to 13.9% for whites. Among DDKT recipients in the earliest cohort, blacks were 39% more likely than whites to experience 5-year graft loss (adjusted hazard ratio [aHR], 1.39; 95% confidence interval [95% CI], 1.32 to 1.47; P<0.001), but this disparity narrowed in the most recent cohort (aHR, 1.10; 95% CI, 1.03 to 1.18; P=0.01). Among LDKT recipients in the earliest cohort, blacks were 53% more likely than whites to experience 5-year graft loss (aHR, 1.53; 95% CI, 1.27 to 1.83; P<0.001), but this disparity also narrowed in the most recent cohort (aHR, 1.37; 95% CI, 1.17 to 1.61; P<0.001). Analyses revealed no statistically significant differences in 1-year or 3-year graft loss after LDKT or DDKT in the most recent cohorts. Our findings of reduced disparities over the last 22 years driven by more markedly improved outcomes for blacks may encourage nephrologists and patients to aggressively promote access to transplantation in the black community.
早期研究报告称，与白人肾移植（KT）受者相比，黑人受者的预后较差。我们研究了近几十年来这种差异是否有所改善。利用移植受者科学注册系统和Cox回归模型，我们比较了1990年至2012年间接受首次活体供肾移植（LDKT）或尸体供肾移植（DDKT）的63910名黑人成年人和145482名白人成年人的全因移植肾丢失情况。在此期间，DDKT后5年移植肾丢失率在黑人中从51.4%降至30.6%，在白人中从37.3%降至25.0%；LDKT后5年移植肾丢失率在黑人中从37.4%降至22.2%，在白人中从20.8%降至13.9%。在最早队列的DDKT受者中，黑人发生5年移植肾丢失的可能性比白人高39%（调整后风险比[aHR]，1.39；95%置信区间[95%CI]，1.32至1.47；P<0.001），但在最近队列中这种差异缩小了（aHR，1.10；95%CI，1.03至1.18；P=0.01）。在最早队列的LDKT受者中，黑人发生5年移植肾丢失的可能性比白人高53%（aHR，1.53；95%CI，1.27至1.83；P<0.001），但在最近队列中这种差异也缩小了（aHR，1.37；95%CI，1.17至1.61；P<0.001）。分析显示，在最近队列中，LDKT或DDKT后1年或3年的移植肾丢失情况无统计学显著差异。我们的研究结果表明，在过去22年中，由于黑人的预后有更显著改善，差异有所减少，这可能会鼓励肾病学家和患者积极推动黑人社区获得移植的机会。
