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从估计的肾小球滤过方程中去除黑人种族系数可提高单个中心黑人患者的移植资格。

Removal of the Black race coefficient from the estimated glomerular filtration equation improves transplant eligibility for Black patients at a single center.

作者信息

Hoenig Melanie P, Mann Alison, Pavlakis Martha

机构信息

Department of Medicine and Transplant Institute, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA.

出版信息

Clin Transplant. 2022 Feb;36(2):e14467. doi: 10.1111/ctr.14467. Epub 2021 Oct 21.

Abstract

Race is a social construct that cannot be measured, can be used imprecisely and may contribute to disparities in kidney transplant access for Black patients. At Beth Israel Deaconess Medical Center, we dropped the Black race coefficient in the estimated glomerular filtration rate (eGFR) report in 2017. We conducted a quality improvement project to examine the impact of this change. Before the change, only 26% of our Black patients were listed for preemptive transplant compared to 70% of White patients. Since the change, we found a steady increase in the percentage of Black patients listed before starting dialysis. The average eGFR at listing prior to 2017 was significantly lower in Black patients but after, there was no longer a significant difference. Nine patients "gained" an average of 457 days of wait time directly related to discarding the Black race coefficient. Increased time on the list prior to dialysis initiation allows for evaluation of potential live donors and improves the possibility of a pre-emptive live or deceased donor transplant and allows for a shorter period on dialysis before transplant. In this single center initiative, we demonstrate the benefit of discarding race from the eGFR report for Black patients awaiting kidney transplantation.

摘要

种族是一种社会建构,无法进行衡量,使用时可能不够精确,且可能导致黑人患者在肾移植机会方面存在差异。在贝斯以色列女执事医疗中心,我们于2017年在估算肾小球滤过率(eGFR)报告中去掉了黑人种族系数。我们开展了一个质量改进项目来研究这一变化的影响。在这一变化之前,我们只有26%的黑人患者被列入优先移植名单,而白人患者的这一比例为70%。自这一变化以来,我们发现开始透析前被列入名单的黑人患者比例稳步上升。2017年之前列入名单时黑人患者的平均eGFR显著更低,但之后就不再有显著差异。九名患者“获得”了平均457天的等待时间,这直接与摒弃黑人种族系数有关。在开始透析前增加在名单上的时间,有助于评估潜在的活体供体,提高进行优先活体或尸体供体移植的可能性,并缩短移植前的透析时间。在这个单中心倡议中,我们证明了在等待肾移植的黑人患者的eGFR报告中摒弃种族因素的益处。

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