高危非裔美国肾移植患者在获得缬更昔洛韦巨细胞病毒预防治疗方面的差异。

Disparities in Access to Valganciclovir Cytomegalovirus Prophylaxis in High-Risk African American Kidney Transplant Patients.

作者信息

Bethi Shipra R, Taber David J, Andrade Erika, Mesmar Zaid M, Calimlim Isabel, Harris Courtney E

机构信息

College of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA.

Department of Surgery, Medical University of South Carolina, Charleston, South Carolina, USA.

出版信息

Transpl Infect Dis. 2025 Mar-Apr;27(2):e14416. doi: 10.1111/tid.14416. Epub 2024 Dec 18.

DOI:10.1111/tid.14416

PMID:39692584

Abstract

BACKGROUND

While access and outcomes disparities for African American (AA) kidney transplant recipients are documented, there are limited studies assessing medication access disparities in transplantation. Cytomegalovirus (CMV) causes severe complications for transplant recipients, and we aimed to understand differences in access to CMV prophylaxis valganciclovir and its impact on CMV infection rates in AA transplant recipients.

METHODS

This single-center, retrospective longitudinal cohort study examined high-risk (CMV serostatus D+/R-) adult kidney transplant recipients between June 1, 2010, and May 31, 202, through EMR abstraction. Standard univariate comparative statistics were employed alongside binary logistic regression for multivariable modeling.

RESULTS

During the 10 year period, 418 kidney transplant recipients were included, with 179 (42.8%) identified as AA and 239 as non-AA. There were significant differences in mean age (p = 0.001) and private versus Medicaid insurance status (p < 0.001). AAs experienced higher death-censored graft loss rates (10.6% AA vs. 5.0% non-AA, p = 0.031). CMV infection rate, opportunistic infection rate, leukopenia incidence, and death did not differ significantly between AA and non-AA patients. AA patients were 42% less likely to receive valganciclovir out-of-pocket cost assistance compared to non-AA patients (OR 0.58, [0.379-0.892], p = 0.013). When incorporating age, Medicaid status, and donor marginality in a multivariable model, the impact of AA race on utilizing assistance programs became statistically non-significant (OR 0.70, [0.448-1.094], p = 0.118).

CONCLUSIONS

AAs were significantly less likely to leverage assistance programs or utilize personal resources to access valganciclovir. This disparity was partially explained by age, insurance status, and donor type. Despite this, CMV infection rates were similar between AA and non-AA cohorts.

摘要

背景

虽然非裔美国（AA）肾移植受者在获得医疗服务和治疗结果方面存在差异已有记录，但评估移植中药物获取差异的研究有限。巨细胞病毒（CMV）会给移植受者带来严重并发症，我们旨在了解AA移植受者在获得CMV预防药物缬更昔洛韦方面的差异及其对CMV感染率的影响。

方法

这项单中心回顾性纵向队列研究通过电子病历摘要，对2010年6月1日至202年5月31日期间的高危（CMV血清学状态D+/R-）成年肾移植受者进行了研究。采用标准单变量比较统计方法，并结合二元逻辑回归进行多变量建模。

结果

在这10年期间，共纳入418名肾移植受者，其中179名（42.8%）为AA受者，239名是非AA受者。平均年龄（p = 0.001）以及私人保险与医疗补助保险状况（p < 0.001）存在显著差异。AA受者的死亡审查后移植失败率更高（AA受者为10.6%，非AA受者为5.0%，p = 0.031）。AA患者和非AA患者之间的CMV感染率、机会性感染率、白细胞减少症发病率和死亡率没有显著差异。与非AA患者相比，AA患者获得缬更昔洛韦自付费用援助的可能性低42%（OR 0.58，[0.379 - 0.892]，p = 0.013）。在多变量模型中纳入年龄、医疗补助状态和供体边缘性后，AA种族对利用援助项目的影响在统计学上变得不显著（OR 0.70，[0.448 - 1.094]，p = 0.118）。