Lv Kaikai, Wu Yangyang, Lai Wenhui, Hao Xiaowei, Xia Xinze, Huang Shuai, Luo Zhenjun, Lv Chao, Qing Yuan, Song Tao
Department of Urology, The Third Medical Centre, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China.
Medical School of Chinese People's Liberation Army (PLA), Beijing, China.
Front Surg. 2023 Jan 9;9:1050416. doi: 10.3389/fsurg.2022.1050416. eCollection 2022.
Race is a prognostic indicator in kidney transplant (KT). However, the effect of donor-recipient race-matching on survival after KT remains unclear.
Using the United Network for Organ Sharing (UNOS) database, a retrospective study was conducted on 244,037 adults who received first-time, kidney-alone transplantation between 2000 and 2019. All patients were categorized into two groups according to donor-recipient race-matching, and the living and deceased donor KT (LDKT and DDKT) were analyzed in subgroups.
Of the 244,037 patients, 149,600 (61%) were race-matched, including 107,351 (87%) Caucasian, 20,741 (31%) African Americans, 17,927 (47%) Hispanics, and 3,581 (25%) Asians. Compared with race-unmatching, race-matching showed a reduced risk of overall mortality and graft loss (unadjusted hazard ratio (HR) 0.86, 95% confidence interval (CI) 0.84-0.87; and unadjusted HR 0.79, 95% CI: 0.78-0.80, respectively). After propensity score-matching, donor-recipient race-matching was associated with a decreased risk of overall graft loss ( < 0.001) but not mortality. In subgroup analysis, race-matching was associated with higher crude mortality (HR 1.12, 95% CI: 1.06-1.20 in LDKT and HR 1.11, 95% CI: 1.09-1.14 in DDKT). However, race-matching was associated with a decreased risk of graft loss in DDKT (unadjusted HR 0.97, 95% CI: 0.96-0.99), but not in LDKT. After propensity score-matching, race-matching had better outcomes for LDKT (patient survival, = 0.047; graft survival, < 0.001; and death-censored graft survival, < 0.001) and DDKT (death-censored graft survival, = 0.018). Nonetheless, race-matching was associated with an increased adjusted mortality rate in the DDKT group ( < 0.001).
Race-matching provided modest survival advantages after KT but was not enough to influence organ offers. Cofounding factors at baseline led to a contorted crude conclusion in subgroups, which was reversed again to normal trends in the combined analysis due to Simpson's paradox caused by the LDKT/DDKT ratio.
种族是肾移植（KT）中的一个预后指标。然而，供受者种族匹配对肾移植术后生存的影响仍不明确。
利用器官共享联合网络（UNOS）数据库，对2000年至2019年间接受首次单纯肾移植的244,037名成年人进行了一项回顾性研究。所有患者根据供受者种族匹配情况分为两组，并对活体供肾肾移植（LDKT）和尸体供肾肾移植（DDKT）进行亚组分析。
在244,037名患者中，149,600名（61%）为种族匹配，其中包括107,351名（87%）白种人、20,741名（31%）非裔美国人、17,927名（47%）西班牙裔和3,581名（25%）亚洲人。与种族不匹配相比，种族匹配显示总体死亡率和移植物丢失风险降低（未调整风险比（HR）为0.86，95%置信区间（CI）为0.84 - 0.87；未调整HR为0.79，95% CI为0.78 - 0.80）。倾向评分匹配后，供受者种族匹配与总体移植物丢失风险降低相关（<0.001），但与死亡率无关。在亚组分析中，种族匹配与较高的粗死亡率相关（LDKT中HR为1.12，95% CI为1.06 - 1.20；DDKT中HR为1.11，95% CI为1.09 - 1.14）。然而，种族匹配与DDKT中移植物丢失风险降低相关（未调整HR为0.97，95% CI为0.96 - 0.99），但与LDKT无关。倾向评分匹配后，种族匹配对LDKT（患者生存率，=0.047；移植物生存率，<0.001；死亡删失移植物生存率，<0.001）和DDKT（死亡删失移植物生存率，=0.018）有更好的结果。尽管如此，种族匹配与DDKT组调整后死亡率增加相关（<0.001）。
种族匹配在肾移植后提供了适度的生存优势，但不足以影响器官分配。基线时的混杂因素导致亚组中得出扭曲的粗结论，由于LDKT/DDKT比例导致的辛普森悖论，在综合分析中又恢复为正常趋势。
