1 Division of Nephrology, Stanford University School of Medicine, Palo Alto, CA. 2 Selzman Institute for Kidney Health, Section of Nephrology, Baylor College of Medicine, Houston, TX.
Transplantation. 2017 Oct;101(10):2636-2647. doi: 10.1097/TP.0000000000001657.
Whether kidney transplantation rates differ by glomerulonephritis (GN) subtype remains largely unknown.
Using the US Renal Data System, we identified all adult patients with end-stage renal disease attributed to 1 of 6 GN subtypes who initiated dialysis in the US (1996-2013). Patients with diabetic nephropathy (DN) and autosomal-dominant polycystic kidney disease (ADPKD) served as "external" non-GN comparators. Using Cox proportional hazards regression, with death considered a competing risk, we estimated hazard ratios (HRs) (95% confidence intervals [CI]) for first kidney transplantation, controlling for year, demographics, comorbidities, socioeconomic factors, and Organ Procurement Organization.
Among 718 480 patients studied, unadjusted and multivariable-adjusted transplant rates differed considerably across GN subtypes. Adjusted transplant rates were highest for patients with IgA nephropathy (IgAN) (referent) and lower for all other groups: focal segmental glomerulosclerosis (HR, 0.80; 95% CI, 0.77-0.82), membranous nephropathy (HR, 0.88; 95% CI, 0.83-0.93), membranoproliferative GN (HR, 0.84; 95% CI, 0.76-0.92), lupus nephritis (HR, 0.69; 95% CI, 0.66-0.71), vasculitis (HR, 0.66; 95% CI, 0.61-0.70), DN (HR, 0.50; 95% CI, 0.47-0.52), ADPKD (HR, 0.85; 95% CI, 0.82-0.88). Reduced kidney transplantation rates among comparator groups were driven more so by lower rates of waitlisting (HRs vs IgAN, ranged from 0.49 for DN to 0.92 for membranous nephropathy or ADPKD) than by lower rates of deceased donor kidney transplantation after waitlisting (rates were only significantly lower, vs IgAN, for those with secondary GN subtypes: lupus nephritis [HR,0.91; 95% CI, 0.86-0.97], vasculitis [HR, 0.85; 95% CI, 0.76-0.94), DN [HR, 0.73; 95% CI, 0.69-0.77]).
Identifying underlying reasons for apparent disease-specific barriers to kidney transplantation might inform center-specific transplant candidate selection procedures, along with national organ allocation policies, leading to more equitable patient care and improved patient outcomes.
肾小球肾炎（GN）亚型导致的终末期肾病患者接受肾移植的比例是否存在差异，目前仍不清楚。
我们利用美国肾脏数据系统，确定了在美国开始透析的所有归因于 6 种 GN 亚型之一的终末期肾病成年患者（1996-2013 年）。糖尿病肾病（DN）和常染色体显性多囊肾病（ADPKD）患者作为“外部”非 GN 对照组。采用 Cox 比例风险回归，以死亡为竞争风险，我们估计了首次肾移植的风险比（HR）（95%置信区间[CI]），控制了年份、人口统计学、合并症、社会经济因素和器官获取组织。
在 718480 名研究患者中，未经调整和多变量调整后的移植率在 GN 亚型之间差异很大。IgA 肾病（IgAN）患者的调整后移植率最高（参照组），而其他所有组的移植率均较低：局灶节段性肾小球硬化症（HR，0.80；95%CI，0.77-0.82）、膜性肾病（HR，0.88；95%CI，0.83-0.93）、膜增殖性 GN（HR，0.84；95%CI，0.76-0.92）、狼疮肾炎（HR，0.69；95%CI，0.66-0.71）、血管炎（HR，0.66；95%CI，0.61-0.70）、DN（HR，0.50；95%CI，0.47-0.52）、ADPKD（HR，0.85；95%CI，0.82-0.88）。与 IgAN 相比，对照组的肾移植率降低，主要是因为候补名单上的患者比例较低（与 IgAN 相比，DN 的 HR 为 0.49，膜性肾病或 ADPKD 的 HR 为 0.92），而不是候补名单后等待死亡供体肾移植的患者比例较低（与 IgAN 相比，只有那些患有继发性 GN 亚型的患者的比率显著较低：狼疮肾炎[HR，0.91；95%CI，0.86-0.97]、血管炎[HR，0.85；95%CI，0.76-0.94]、DN[HR，0.73；95%CI，0.69-0.77]）。
确定导致肾移植明显的疾病特异性障碍的潜在原因，可能有助于确定特定中心的移植候选者选择程序，以及国家器官分配政策，从而为患者提供更公平的护理和改善患者的预后。
