Department of Surgery, Division of Transplantation, University of Alabama at Birmingham, Birmingham, AL.
Department of Medicine, Division of Nephrology, University of Alabama at Birmingham, Birmingham, AL.
Ann Surg. 2019 Oct;270(4):639-646. doi: 10.1097/SLA.0000000000003484.
In this study, we sought to assess likelihood of living donor kidney transplantation (LDKT) within a single-center kidney transplant waitlist, by race and sex, after implementation of an incompatible program.
Disparities in access to LDKT exist among minority women and may be partially explained by antigen sensitization secondary to prior pregnancies, transplants, or blood transfusions, creating difficulty finding compatible matches. To address these and other obstacles, an incompatible LDKT program, incorporating desensitization and kidney paired donation, was created at our institution.
A retrospective cohort study was performed among our kidney transplant waitlist candidates (n = 8895). Multivariable Cox regression was utilized, comparing likelihood of LDKT before (era 1: 01/2007-01/2013) and after (era 2: 01/2013-11/2018) implementation of the incompatible program. Candidates were stratified by race [white vs minority (nonwhite)], sex, and breadth of sensitization.
Program implementation resulted in the nation's longest single-center kidney chain, and likelihood of LDKT increased by 70% for whites [adjusted hazard ratio (aHR) 1.70; 95% confidence interval (CI), 1.46-1.99] and more than 100% for minorities (aHR 2.05; 95% CI, 1.60-2.62). Improvement in access to LDKT was greatest among sensitized minority women [calculated panel reactive antibody (cPRA) 11%-49%: aHR 4.79; 95% CI, 2.27-10.11; cPRA 50%-100%: aHR 4.09; 95% CI, 1.89-8.82].
Implementation of an incompatible program, and the resulting nation's longest single-center kidney chain, mitigated disparities in access to LDKT among minorities, specifically sensitized women. Extrapolation of this success on a national level may further serve these vulnerable populations.
本研究旨在评估在实施不相容方案后，按种族和性别在单一中心肾移植等待名单中活体供肾移植（LDKT）的可能性。
少数族裔女性获得 LDKT 的机会存在差异，这可能部分归因于先前妊娠、移植或输血引起的抗原致敏，导致难以找到匹配的供体。为了解决这些问题和其他障碍，我们机构创建了一个不相容的 LDKT 项目，包括脱敏和肾配对捐赠。
对我们的肾移植等待名单候选人（n=8895）进行了回顾性队列研究。使用多变量 Cox 回归比较了不相容方案实施前后（时期 1：2007 年 1 月至 2013 年 1 月；时期 2：2013 年 1 月至 2018 年 11 月）LDKT 的可能性。候选人按种族[白人与少数族裔（非白人）]、性别和致敏程度进行分层。
该方案的实施产生了全国最长的单一中心肾移植链，白人 LDKT 的可能性增加了 70%（调整后的危险比[aHR]1.70；95%置信区间[CI]，1.46-1.99），少数族裔增加了 100%以上（aHR 2.05；95%CI，1.60-2.62）。在致敏少数族裔女性中，LDKT 获得机会的改善最大[计算的 panel reactive antibody（cPRA）11%-49%：aHR 4.79；95%CI，2.27-10.11；cPRA 50%-100%：aHR 4.09；95%CI，1.89-8.82]。
不相容方案的实施以及由此产生的全国最长的单一中心肾移植链，缓解了少数族裔，特别是致敏女性获得 LDKT 的机会不平等。在全国范围内推广这一成功可能会进一步服务于这些弱势群体。
