University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota.
S D Med. 2022 Oct;75(10):460.
Indigenous people experience higher rates of end-stage renal disease as well as negative predictive factors such as medical comorbidities, lower socioeconomic status, greater waitlist time, and fewer pre-emptive transplants that undermine kidney transplantation success. In addition, Indian tribal reservation-dwelling Indigenous people may also be disproportionately affected by poverty, geographical disadvantages, limited physician availability, lower health literacy and cultural beliefs that further reduce access to care. Historically, all racial minority groups have experienced higher rates of rejection events, graft failure and mortality relating to these inequalities. Recent data suggests that short-term outcomes in Indigenous people are comparable to other racial groups, but few studies have examined this effect in the northern Great Plains region.
A retrospective database review was performed to determine outcomes of kidney transplantation in Indigenous people of the Northern Great Plains region. White and Indigenous people receiving a kidney transplant, between 2000 and 2018, at a single center, Avera McKennan Hospital in Sioux Falls, South Dakota, were included. Outcomes assessed between one month and 10 years post-transplant included estimated glomerular filtration rate, biopsy-proven acute rejection events, graft failure, patient survival, and death-censored graft failure. All transplant recipients had a minimum of one year of follow-up after transplant.
A total of 622 kidney transplant recipients were included (117 Indigenous and 505 White). Indigenous recipients were more likely to smoke, have diabetes, have higher immunologic risk, receive fewer living donor kidneys, and have longer wait-list times. In the five years following kidney transplant, there were no significant differences in renal function, rejection events, cancer, graft failure or patient survival. At 10 years post-transplant, Indigenous recipients had twice the all-cause graft failure (OR 2.06; CI 1.25-3.39) and half the survival (OR 0.47; CI 0.29-0.76), however this effect was not maintained once the effect of race was adjusted for sex, smoking status, diabetes, preemptive transplant, high panel reactive antibody status and transplant type.
This retrospective study found that, despite differences in baseline characteristics, a population of Indigenous kidney transplant recipients at a single center in the Northern Great Plains region had no statistically significant differences in transplant outcomes in the first five years after transplant compared with their White counterparts. Racial differences emerged in graft failure and patient survival at 10 years after renal transplant, with Indigenous individuals more likely to experience negative long-term outcomes, but once covariates were adjusted for, this effect became insignificant. A number of these covariates are potentially modifiable, and a greater focus on addressing risk factor disparity could help extend the excellent five-year kidney transplant outcomes into long-term success in Indigenous people.
土著人患有终末期肾病的比率较高，而且存在许多负面预测因素，如合并症、较低的社会经济地位、更长的等待时间、以及更少的抢先移植，这些因素都对肾移植的成功产生不利影响。此外，印第安部落保留地的土著人可能也受到贫困、地理位置不利、医生资源有限、较低的健康素养和文化信仰的不成比例影响，这些因素进一步限制了他们获得医疗服务的机会。历史上，所有少数族裔群体的排斥反应、移植物失功和死亡率都与这些不平等有关。最近的数据表明，土著人的短期预后与其他种族群体相当，但很少有研究在北普拉特地区考察这种影响。
对单中心（南达科他州苏福尔斯的 Avera McKennan 医院）的数据库进行回顾性分析，以确定北普拉特地区土著人肾移植的结果。纳入在 2000 年至 2018 年期间接受肾移植的白人及土著人群。在移植后 1 个月至 10 年内评估的结果包括估算肾小球滤过率、活检证实的急性排斥反应事件、移植物失功、患者存活率和死亡相关移植物失功。所有移植受者在移植后至少有 1 年的随访。
共纳入 622 例肾移植受者（117 例为土著人，505 例为白人）。与白人受者相比，土著人受者更有可能吸烟、患有糖尿病、免疫风险更高、接受活体供肾较少、等待时间更长。在肾移植后 5 年内，肾功能、排斥反应事件、癌症、移植物失功或患者存活率无显著差异。在移植后 10 年，土著人受者的全因移植物失功风险增加两倍（OR 2.06；CI 1.25-3.39），存活率减半（OR 0.47；CI 0.29-0.76），但在调整种族对性别、吸烟状况、糖尿病、抢先移植、高 panel reactive antibody 状态和移植类型的影响后，这种差异不再具有统计学意义。
本回顾性研究发现，尽管存在基线特征差异，但在北普拉特地区的单中心中，一群土著肾移植受者在移植后 5 年内的移植结果与白人受者相比，没有统计学上的显著差异。在肾移植后 10 年，土著人受者的移植物失功和患者存活率出现差异，土著人更有可能出现不良的长期预后，但在调整了混杂因素后，这种影响变得不显著。这些混杂因素中的许多是可以改变的，更加关注危险因素的差异，可能有助于将土著人在 5 年内的优秀肾移植结果扩展到长期成功。
