Huang Shuai, Xia Xinze, Lai Wenhui, Hao Xiaowei, Wu Yangyang, Lv Kaikai, Luo Zhenjun, Romão Elen Almeida, Ciancio Gaetano, Lv Chao, Meng Qingyang, Yu Tao, Yuan Qing
Department of Urology, The Third Medical Center, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China.
Department of Postgraduate, Hebei North University, Zhangjiakou, China.
Transl Androl Urol. 2023 Jul 31;12(7):1137-1154. doi: 10.21037/tau-23-288. Epub 2023 Jul 11.
Previous studies have shown that education level is associated with the prognosis of cadaveric kidney transplant recipients. However, it is unclear whether education affects the prognosis of living kidney transplant (LDKT) recipients. In addition, it remains to be determined whether the uneven distribution of educational levels consistently affects the prognosis of LDKT recipients across ethnic groups (White, Black, Hispanic and Asian).
After establishing inclusion and exclusion criteria, we conducted a retrospective study of LDKT recipients who received their first single LDKT between 2005 and 2020. The LDKT recipients were divided into lower- and higher-education groups according to categorize the educational level of recipients, and transplant outcomes, including graft survival, patient survival, and death-censored graft survival (DCGS), were analyzed and compared.
Graft survival, DCGS and patient mortality were significantly better in the higher-education group compared with those in the lower-education group (P<0.001), with the risk of graft failure, death censored graft failure (DCGF) and patient mortality increasing by 11%, 15% and 7% in the lower-education group, respectively. Furthermore, compared with the higher-education group, the risk of graft failure in Black recipients increased by 18% [adjusted hazard ratio (aHR), 1.18; 95% confidence interval (CI): 1.07 to 1.30], and the risk of patient mortality among White recipients decreased by 7% (aHR, 0.93; 95% CI: 0.87 to 0.99). However, there were no significant differences in graft failure and patient mortality among Hispanic and Asian recipients, respectively.
This study revealed that LDKT recipients with a higher education level had better transplant outcomes. However, these transplant outcome differences were mainly found in White and Black recipients. These data confirm the significant effect of different levels of education on the prognosis of LDKT recipients.
既往研究表明，教育水平与尸体肾移植受者的预后相关。然而，教育是否会影响活体肾移植（LDKT）受者的预后尚不清楚。此外，教育水平的不均衡分布是否会持续影响不同种族（白人、黑人、西班牙裔和亚裔）的LDKT受者的预后仍有待确定。
在确定纳入和排除标准后，我们对2005年至2020年间接受首次单次LDKT的受者进行了一项回顾性研究。根据受者的教育水平将LDKT受者分为低教育组和高教育组，并对移植结局，包括移植物存活、患者存活和死亡删失移植物存活（DCGS）进行分析和比较。
与低教育组相比，高教育组的移植物存活、DCGS和患者死亡率显著更好（P<0.001），低教育组的移植物失败、死亡删失移植物失败（DCGF）和患者死亡率风险分别增加了11%、15%和7%。此外，与高教育组相比，黑人受者的移植物失败风险增加了18%[调整后风险比（aHR），1.18；95%置信区间（CI）：1.07至1.30]，白人受者的患者死亡率风险降低了7%（aHR，0.93；95%CI：0.87至0.99）。然而，西班牙裔和亚裔受者的移植物失败和患者死亡率之间分别没有显著差异。
本研究表明，教育水平较高的LDKT受者具有更好的移植结局。然而，这些移植结局差异主要见于白人和黑人受者。这些数据证实了不同教育水平对LDKT受者预后的显著影响。
