Department of Medicine, University of Miami Miller School of Medicine, Miami, FL.
Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
Transplantation. 2021 Aug 1;105(8):1850-1857. doi: 10.1097/TP.0000000000003511.
BACKGROUND: Transplantation of kidneys from hepatitis C virus (HCV)-viremic donors into HCV-negative patients followed by direct-acting antiviral therapy was an important breakthrough to increase the number of life-saving kidney transplants. Data suggest that these transplants offer several benefits; however, it is unknown whether adoption of this practice has been shared equitably, especially among disadvantaged groups. METHODS: We evaluated United Network for Organ Sharing data on HCV-seronegative adult deceased-donor kidney transplant recipients from January 1, 2017, to June 12, 2020. We compared recipients of a kidney from an HCV antibody- (Ab-)/nucleic acid test- (NAT-), HCV Ab+/NAT-, and HCV NAT+ donor. The primary covariates were as follows: (1) race/ethnicity; (2) female sex; and (3) highest level of education. Models included variables associated with being offered an HCV NAT+ kidney. We fit mixed-effects multinomial logistic regression models with the center as a random effect to account for patient clustering. RESULTS: Of 48 255 adult kidney-alone deceased-donor kidney transplant HCV-seronegative recipients, 1641 (3.4%) donors were HCV NAT+-, increasing from 0.3% (January 2017-June 2017) to 6.9% (January 2020-June 2020). In multivariable models, racial/ethnic minorities, women, and those with less education were significantly less likely to receive a kidney from an HCV NAT+ donor relative to an HCV Ab-/NAT- and HCV Ab+/NAT- donor. The disparities were most pronounced among Hispanic and Asian patients with less educational attainment (grade school, high school, or some college/tech school). CONCLUSIONS: Despite an increase in transplants from HCV NAT+ donors, we found substantial racial/ethnic disparities in transplantation of these kidneys. These data highlight how the benefits of a scientific breakthrough are often made less available to disadvantaged patients.
背景:将来自丙型肝炎病毒(HCV)病毒血症供体的肾脏移植到 HCV 阴性患者体内,然后进行直接作用抗病毒治疗,这是增加挽救生命的肾脏移植数量的重要突破。有数据表明,这些移植具有多项益处;然而,尚不清楚这种做法是否得到了公平的采用,特别是在弱势群体中。
方法:我们评估了 2017 年 1 月 1 日至 2020 年 6 月 12 日期间接受 HCV 血清阴性成人尸体供肾移植的 United Network for Organ Sharing 数据。我们比较了接受 HCV 抗体(Ab)/核酸检测(NAT)阴性、HCV Ab+/NAT-和 HCV NAT+供体肾脏的受者。主要协变量如下:(1)种族/族裔;(2)女性;(3)最高教育程度。模型纳入了与提供 HCV NAT+肾脏相关的变量。我们采用混合效应多项逻辑回归模型,以中心为随机效应,以解释患者的聚类。
结果:在 48255 名 HCV 血清阴性的成人单独尸体供肾移植受者中,有 1641 名(3.4%)供者为 HCV NAT+,从 2017 年 1 月至 6 月的 0.3%增加到 2020 年 1 月至 6 月的 6.9%。在多变量模型中,与 HCV Ab-/NAT-和 HCV Ab+/NAT-供体相比,少数族裔、女性和教育程度较低的人群接受 HCV NAT+供体肾脏的可能性显著降低。在教育程度较低的西班牙裔和亚裔患者中,这种差异最为显著(小学、中学或大专/技术学校)。
结论:尽管来自 HCV NAT+供体的移植有所增加,但我们发现这些肾脏移植存在显著的种族/族裔差异。这些数据突显了科学突破的益处如何往往更不容易为弱势患者所获得。
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