School of Health and Rehabilitation Sciences, The Ohio State University, Columbus.
Center for Biostatistics, The Ohio State University, Columbus.
JAMA Surg. 2023 Apr 1;158(4):386-392. doi: 10.1001/jamasurg.2022.7753.
Improving equity in organ transplant access for people with intellectual and developmental disabilities (IDD) is a topic of social discourse in mainstream media, state legislation, and national legislation. However, few studies have compared evaluation rates, transplant rates, and outcomes among adults with and without IDD.
To compare rates of kidney transplant and transplant-specific outcomes between propensity-score matched groups of adults with end-stage kidney disease (ESKD [also referred to as end-stage renal disease (ESRD)]) with and without co-occurring IDD.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study included all Medicare inpatient and outpatient standard analytical files from 2013 through 2020. A total of 1 413 655 adult Medicare beneficiaries with ESKD were identified. Propensity-score matching was used to balance cohorts based on age, sex, race, follow-up duration, and Charlson Comorbidity Index. The matched cohorts consisted of 21 384 adults with ESKD (10 692 of whom had IDD) and 1258 kidney transplant recipients (629 of whom had IDD). Data were analyzed between June 1, 2022, and August 1, 2022.
IDD.
Evaluation for kidney transplant, receipt of kidney transplant, perioperative complications, readmission, mortality, graft rejection, and graft failure.
Of the 21 384 propensity-score matched adults with ESKD, the median (IQR) age was 55 (43-65) years, 39.2% were male, 27.4% were Black, 64.1% were White, and 8.5% identified as another race or ethnicity. After propensity score matching within the ESKD cohort, 633 patients with IDD (5.9%) received a kidney transplant compared with 1367 of adults without IDD (12.8%). Adults with IDD were 54% less likely than matched peers without IDD to be evaluated for transplant (odds ratio, 0.46; 95% CI, 0.43-0.50) and 62% less likely to receive a kidney transplant (odds ratio, 0.38; 95% CI, 0.34-0.42). Among matched cohorts of kidney transplant recipients, rates of perioperative complications, readmission, and graft failure were similar for adults with and without IDD.
Using the largest cohort of adult kidney transplant recipients with IDD to date, the study team found that rates of evaluation and transplant were lower despite yielding equivalent outcomes. These data support consideration of adults with IDD for kidney transplant and underscore the urgent need for antidiscrimination initiatives to promote the receipt of equitable care for this population.
为智障和发育障碍（ID）患者提供器官移植机会的公平性是主流媒体、州立法和国家立法中的一个社会话题。然而，很少有研究比较过有和没有 ID 的成年人的评估率、移植率和结果。
比较患有终末期肾病（ESKD [也称为终末期肾脏疾病（ESRD）]）的伴有和不伴有智力障碍的成年人的肾移植率和特定移植结果。
设计、地点和参与者：这是一项回顾性队列研究，纳入了 2013 年至 2020 年期间所有的 Medicare 住院和门诊标准分析文件。共确定了 1413655 名患有 ESKD 的成年 Medicare 受益人。采用倾向评分匹配法，根据年龄、性别、种族、随访时间和 Charlson 合并症指数对队列进行平衡。匹配队列包括 21384 名患有 ESKD 的成年人（其中 10692 人患有 ID）和 1258 名肾移植受者（其中 629 人患有 ID）。数据分析于 2022 年 6 月 1 日至 2022 年 8 月 1 日进行。
智力障碍。
接受肾移植的评估、接受肾移植、围手术期并发症、再入院、死亡率、移植物排斥、移植物衰竭。
在 21384 名接受 ESKD 倾向评分匹配的成年人中，中位（IQR）年龄为 55（43-65）岁，39.2%为男性，27.4%为黑人，64.1%为白人，8.5%为其他种族或族裔。在 ESKD 队列内进行倾向评分匹配后，633 名 ID 患者（5.9%）接受了肾移植，而 1367 名无 ID 的成年人（12.8%）接受了肾移植。与没有 ID 的匹配同龄人相比，有 ID 的成年人接受移植评估的可能性低 54%（优势比，0.46；95%CI，0.43-0.50），接受肾移植的可能性低 62%（优势比，0.38；95%CI，0.34-0.42）。在肾移植受者的匹配队列中，有和没有 ID 的成年人的围手术期并发症、再入院和移植物衰竭的发生率相似。
使用迄今为止最大的有 ID 的成年肾移植受者队列，研究小组发现，尽管结果相当，但评估和移植的比例较低。这些数据支持考虑为 ID 成年人进行肾移植，并强调迫切需要采取反歧视举措，为这一人群提供公平的护理。
