Rabbani Muhammad Umaid, Reed Rhiannon D, McLeod Marshall C, MacLennan Paul A, Kumar Vineeta, Locke Jayme E
From the Comprehensive Transplant Institute, University of Alabama at Birmingham, Birmingham, AL.
J Am Coll Surg. 2024 Apr 1;238(4):647-653. doi: 10.1097/XCS.0000000000000970. Epub 2024 Mar 15.
Live donor kidney transplantation has been popularized to help mitigate the organ shortage crisis. At the time of living donor nephrectomy, living donors lose 50% of their kidney function or glomerular filtration rate (GFR). Studies have shown that in healthy living donors, the remaining kidney is able to adapt and recover 10% to 25% of postdonation lost GFR. GFR recovery is critical to long-term kidney health, particularly for Black Americans who disproportionately suffer from kidney disease with an incidence 2.5 times White Americans. To date, no study has examined whether health inequities in renal recovery postdonation exist.
We retrospectively analyzed 100,121 living kidney donors reported to the Scientific Registry of Transplant Recipients between 1999 and 2021. We estimated GFR (eGFR) using the Chronic Kidney Disease Epidemiology Collaboration 2021 equation and predicted the likelihood (logistic regression) and time (Cox regression) to recovery of 60% and 75% predonation eGFR. Models adjusted for age, sex, race, BMI, and predonation eGFR.
Black patients were 47% (adjusted odds ratio 0.53, 95% CI 0.50 to 0.56, p < 0.001) and 43% (adjusted odds ratio 0.57, 95% CI 0.54 to 0.60, p < 0.001) less likely to recover 60% and 75% of predonation eGFR, respectively, compared with their White counterparts. The hazard ratio for time to renal recovery of 60% and 75% of predonation eGFR was 22% (adjusted hazard ratio 0.78, 95% CI 0.76 to 0.80, p < 0.001) and 38% (adjusted hazard ratio 0.62, 95% CI 0.60 to 0.65, p < 0.001) lower, respectively, than White patients.
Black living kidney donors were less likely to recover predonation eGFR, and time to renal recovery was significantly longer than their White counterparts. These data highlight the need for enhanced living kidney donor follow-up, particularly for Black living kidney donors who are at greatest future risk of end-stage kidney disease.
活体供肾移植已得到普及，以帮助缓解器官短缺危机。在活体供肾肾切除术时，活体供者会失去50%的肾功能或肾小球滤过率（GFR）。研究表明，在健康的活体供者中，剩余的肾脏能够适应并恢复捐赠后丢失的GFR的10%至25%。GFR的恢复对肾脏的长期健康至关重要，尤其是对于美国黑人而言，他们患肾脏疾病的比例过高，发病率是美国白人的2.5倍。迄今为止，尚无研究探讨捐赠后肾脏恢复方面是否存在健康不平等现象。
我们回顾性分析了1999年至2021年期间向移植受者科学登记处报告的100121例活体肾供者。我们使用慢性肾脏病流行病学协作组2021年的方程估算GFR（eGFR），并预测恢复至捐赠前eGFR的60%和75%的可能性（逻辑回归）及时间（Cox回归）。模型对年龄、性别、种族、BMI和捐赠前eGFR进行了校正。
与白人供者相比，黑人患者恢复至捐赠前eGFR的60%和75%的可能性分别降低了47%（校正比值比0.53，95%置信区间0.50至0.56，p<0.001）和43%（校正比值比0.57，95%置信区间0.54至0.60，p<0.001）。恢复至捐赠前eGFR的60%和75%的肾脏恢复时间的风险比分别降低了22%（校正风险比0.78，95%置信区间0.76至0.80，p<0.001）和38%（校正风险比0.62，95%置信区间0.60至0.65，p<0.001），均低于白人患者。
黑人活体肾供者恢复捐赠前eGFR的可能性较小，肾脏恢复时间明显长于白人供者。这些数据凸显了加强对活体肾供者随访的必要性，尤其是对于未来患终末期肾病风险最高的黑人活体肾供者。
