Zheng Catherine, Teixeira-Pinto Armando, Hughes Jaquelyne T, Sinka Victoria, van Zwieten Anita, Lim Wai H, Wong Germaine
Sydney Medical School, The University of Sydney, Camperdown, New South Wales, Australia.
Centre for Kidney Research, Kids Research Institute, The Children's Hospital at Westmead, New South Wales, Australia.
Kidney Int Rep. 2022 Sep 3;7(11):2495-2504. doi: 10.1016/j.ekir.2022.08.027. eCollection 2022 Nov.
Aboriginal and Torres Strait Islander peoples (hereafter respectfully termed Indigenous Australians) experience a 3-fold increased risk of acute rejection after transplantation compared to non-Indigenous Australians. We investigated whether acute rejection explains the association between Indigenous status, infection-related deaths, and all-cause deaths after kidney transplantation, and whether acute rejection mediates the relationship between Indigenous status and overall graft loss.
This cohort study included all recipients who received their first kidney transplant between 2005 and 2018 in Australia, using data from the Australia and New Zealand Dialysis and Transplant registry. Multivariable Cox regression models determined the associations between Indigenous status, graft loss, infection-related deaths, and all-cause deaths. Mediation analyses examined if acute rejection mediated these relationships. Primary outcome was infection-related death. Secondary outcomes included all-cause death and overall graft loss.
There were 9993 patients ( = 390 (3.9%) Indigenous Australians) who received a kidney transplant between 2005 and 2018, and they were followed-up with for 56,876 patient-years. A total of 1165 died (12%) (211 infection-related deaths) and 1957 (20%) lost their allografts. Compared with non-Indigenous recipients, the adjusted hazard ratio (HR) (95% confidence interval [CI]) for graft loss, infection-related deaths and all-cause deaths among Indigenous Australians were 2.27 (1.90-2.71), 3.01 (1.90-4.77) and 2.36 (1.89-2.94), respectively. The mediation analysis showed the association between Indigenous status and graft loss (but not infection-related death or all-cause death) was partially mediated by acute rejection (1.06 [1.03-1.09]), and the proportion of effects mediated by acute rejection was 0.10.
Indigenous Australians experienced a higher risk of graft loss, a relationship mediated partially through acute rejection. The higher risk of infection-related death was independent of acute rejection.
与非澳大利亚原住民相比，澳大利亚原住民和托雷斯海峡岛民（以下统称为澳大利亚原住民）在移植后发生急性排斥反应的风险增加了两倍。我们调查了急性排斥反应是否能解释原住民身份、感染相关死亡与肾移植后全因死亡之间的关联，以及急性排斥反应是否介导了原住民身份与整体移植物丢失之间的关系。
这项队列研究纳入了2005年至2018年在澳大利亚接受首次肾移植的所有受者，使用了澳大利亚和新西兰透析与移植登记处的数据。多变量Cox回归模型确定了原住民身份、移植物丢失、感染相关死亡和全因死亡之间的关联。中介分析检验了急性排斥反应是否介导了这些关系。主要结局是感染相关死亡。次要结局包括全因死亡和整体移植物丢失。
2005年至2018年期间，共有9993例患者（n = 390例（3.9%）为澳大利亚原住民）接受了肾移植，并对他们进行了56876患者年的随访。共有1165例患者死亡（12%）（211例与感染相关的死亡），1957例（20%）失去了同种异体移植物。与非原住民受者相比，澳大利亚原住民移植物丢失、感染相关死亡和全因死亡的调整后风险比（HR）（95%置信区间[CI]）分别为2.27（1.90 - 2.71）、3.01（1.90 - 4.77）和2.36（1.89 - 2.94）。中介分析表明，原住民身份与移植物丢失（但不是感染相关死亡或全因死亡）之间的关联部分由急性排斥反应介导（1.06 [1.03 - 1.09]），急性排斥反应介导的效应比例为0.10。
澳大利亚原住民发生移植物丢失的风险更高，这种关系部分通过急性排斥反应介导。感染相关死亡的较高风险与急性排斥反应无关。
