Division of Medicine, Mayo Clinic Arizona, Phoenix, Arizona, USA.
Department of Surgery, Mayo Clinic Arizona, Phoenix, Arizona, USA.
Clin Transplant. 2023 Oct;37(10):e15062. doi: 10.1111/ctr.15062. Epub 2023 Jun 28.
The objective of this study was to compare the long-term outcomes of Hispanic versus white recipients who underwent simultaneous pancreas kidney transplantation (SPKT). This single-center study, conducted from 2003 to 2022, had a median follow-up of 7.5 years. The study included 91 Hispanic and 202 white SPKT recipients. The mean age (44 vs. 46 years), percentage of males (67% vs. 58%), and body mass index (BMI) (25.6 vs. 25.3 kg/m ) were similar between the Hispanic and white groups. The Hispanic group had more recipients with type 2 diabetes (38%) compared to the white group (5%, p < .001). The duration of dialysis was longer in Hispanics (640 vs. 473 days, p = .02), and fewer patients received preemptive transplants (10% vs. 29%, p < .01) compared to whites. Hospital length of stay, rates of BK Viremia, and acute rejection episodes within 1 year were similar between the groups. The estimated 5-year kidney, pancreas, and patient survival rates were also similar between the groups, 94%, 81%, and 95% in Hispanics, compared to 90%, 79%, and 90% in whites. Increasing age and longer duration of dialysis were risk factors for death. Although Hispanic recipients had a longer duration on dialysis and fewer preemptive transplants, the survival rates were similar to those of white recipients. However, referring providers and many transplant centers continue to overlook pancreas transplants for appropriately selected patients with type 2 diabetes, particularly among minority populations. As a transplant community, it is crucial that we make efforts to comprehend and tackle these obstacles to transplantation.
本研究旨在比较接受胰肾联合移植(SPKT)的西班牙裔和白人受者的长期结局。这项单中心研究于 2003 年至 2022 年进行,中位随访时间为 7.5 年。研究纳入了 91 名西班牙裔和 202 名白人 SPKT 受者。两组间的平均年龄(44 岁比 46 岁)、男性比例(67%比 58%)和体重指数(BMI)(25.6 千克/平方米比 25.3 千克/平方米)相似。西班牙裔组中患有 2 型糖尿病的受者比例(38%)高于白人组(5%,p<0.001)。西班牙裔患者的透析时间更长(640 天比 473 天,p=0.02),接受预防性移植的患者比例更少(10%比 29%,p<0.01)。两组患者的住院时间、BK 病毒血症发生率和 1 年内急性排斥反应发生率相似。两组间的 5 年肾、胰腺和患者存活率也相似,西班牙裔组分别为 94%、81%和 95%,而白人组分别为 90%、79%和 90%。年龄增加和透析时间延长是死亡的危险因素。尽管西班牙裔受者的透析时间更长,且接受预防性移植的比例更低,但他们的存活率与白人受者相似。然而,许多转诊医生和移植中心继续忽视适合接受胰腺移植的 2 型糖尿病患者,尤其是少数族裔患者。作为移植界,我们必须努力理解和解决这些移植障碍。