Krishnamoorthy Sambhavi, Satishchandra Niveditha Girimaji, Chapman Arlene, McGill Rita
Section of Nephrology, University of Chicago Medicine, Chicago, Illinois.
Nephrology and Hypertension Division, University of Kansas, Kansas City, Kansas.
Clin J Am Soc Nephrol. 2025 Apr 1;20(4):563-572. doi: 10.2215/CJN.0000000626. Epub 2025 Jan 28.
Despite overall superior outcomes, transplant outcomes of patients with autosomal dominant polycystic kidney disease are heavily influenced by race. Access to living donor and preemptive transplantation partly explains these racial disparities. Favorable Expected Post-Transplant Survival scores suggest that promoting equity would result in improved survival for patients with ADPKD.
Autosomal dominant polycystic kidney disease (ADPKD) is the most common genetic cause of ESKD and occurs without racial predilection. In general, non-White patients with ESKD have less access to transplantation, especially living donor transplantation. We examined long-term outcomes of patients with ADPKD-ESKD by self-reported race, with attention to the trajectory of Estimated Post-Transplant Survival (EPTS) scores over time.
United Network for Organ Sharing Standard Transplant Analysis and Research files were used to identify 32,611 ADPKD transplant recipients between January 2000 and December 2022. EPTS scores were calculated from the date of waitlisting until transplantation occurred. Cumulative incidences of living and deceased transplantation were calculated and plotted. Cox models were made for graft failure and death, and a subdistribution hazards model for graft failure accounted for death as a competing outcome, with adjustment for patient, donor, and transplant factors.
Compared with White patients with ADPKD, all other groups had more dialysis years, more delayed graft function, and fewer living and preemptive transplants; mean EPTS scores were lower in Black and Hispanic patients at each time point on the waitlist. However, EPTS scores at the time of transplant was less likely to be <20% in Black and Hispanic patients because of longer waiting time. Black patients had a significantly higher risk of graft failure with death as competing risk compared with White patients. Asian and Hispanic patients had similar graft survivals but better patient survival compared with White patients.
Waitlist experience, allograft quality, and post-transplant outcomes of patients with ADPKD are influenced by patient race.
尽管总体移植结局更佳，但常染色体显性多囊肾病患者的移植结局受种族影响很大。活体供体肾移植和抢先移植的可及性在一定程度上解释了这些种族差异。良好的预期移植后生存评分表明，促进公平将改善常染色体显性多囊肾病患者的生存情况。
常染色体显性多囊肾病（ADPKD）是终末期肾病（ESKD）最常见的遗传病因，无种族倾向。一般而言，ESKD的非白人患者接受移植的机会较少，尤其是活体供体肾移植。我们根据自我报告的种族研究了ADPKD-ESKD患者的长期结局，并关注估计移植后生存（EPTS）评分随时间的变化轨迹。
利用器官共享联合网络标准移植分析和研究文件，确定2000年1月至2022年12月期间的32,611例ADPKD移植受者。从列入等待名单之日起计算EPTS评分，直至移植发生。计算并绘制活体和尸体移植的累积发生率。建立移植失败和死亡的Cox模型，移植失败的亚分布风险模型将死亡作为竞争结局，并对患者、供体和移植因素进行调整。
与ADPKD白人患者相比，所有其他组的透析年限更长，移植肾功能延迟恢复更多，活体和抢先移植更少；在等待名单上的每个时间点，黑人和西班牙裔患者的平均EPTS评分更低。然而，由于等待时间更长，黑人和西班牙裔患者移植时的EPTS评分低于20%的可能性较小。与白人患者相比，黑人患者在以死亡作为竞争风险时移植失败的风险显著更高。与白人患者相比，亚洲和西班牙裔患者的移植肾存活率相似，但患者生存率更高。
ADPKD患者的等待名单经历、同种异体肾质量和移植后结局受患者种族影响。
