Tesi R J, DeboisBlanc M, Saul C, O'Donovan R, Etheredge E
Department of Surgery and Department of Medicine, Tulane University Medical Center, New Orleans, Louisiana 70112, USA.
Transplantation. 1995 Dec 27;60(12):1401-6. doi: 10.1097/00007890-199560120-00005.
Black kidney transplant recipients have worse graft survival than white recipients. Speculation regarding etiology has focused on differences in human lymphocyte antigens (HLA). Some suggest that improvements in graft survival would be obtained if donor and recipient race were matched. We reviewed 236 cadaver transplants performed over 9 years at a single center using an HLA-match-driven allocation system and a uniform immunosuppressive protocol to determine the impact of donor race on graft survival. A multivariate analysis of graft survival using patient race, sex, age, transplant number, current and maximum plasma renin activity, donor race, cold ischemia time and HLA mismatch, the need for dialysis, and the presence of rejection as independent variables. Sixty percent of recipients were black, and 82% were primary transplants; 28 kidneys (12%) were from black donors. The 112 patients with the same race donor had identical 5-year graft survival as the 124 who had a different race donor (40%; P = 0.1726). The 5-year survival of the 88 white recipients of white donor organs was better than that of the 120 black recipients of white donor organs (54% vs. 42%, respectively; P = 0.0398). Black recipients (t1/2 = 37 months) did worse than white recipients (t1/2 = 60 months) regardless of organ source (P = 0.023). In the multivariate analysis, neither donor nor recipient race were an independent variable in predicting graft survival. Rejection (RR = 2.9) and the need for dialysis on the transplant admission (RR = 4.1) were the only factors that predicted poor survival. Black recipients had more rejection (P = 0.04) but not more need for dialysis posttransplant regardless of donor race. Donor race did not affect graft survival in this series. The effect of recipient race on graft survival was due to an increased incidence of rejection episodes in black recipients, which was independent of HLA mismatch. These data suggest that improvements in immunosuppression, not changes in allocation, are needed to improve graft survival.
黑人肾移植受者的移植物存活率低于白人受者。关于病因的推测主要集中在人类淋巴细胞抗原（HLA）的差异上。一些人认为，如果供体和受者的种族相匹配，移植物存活率将会提高。我们回顾了在一个中心9年期间进行的236例尸体肾移植，该中心采用HLA匹配驱动的分配系统和统一的免疫抑制方案，以确定供体种族对移植物存活率的影响。使用患者的种族、性别、年龄、移植次数、当前和最大血浆肾素活性、供体种族、冷缺血时间和HLA错配、透析需求以及排斥反应的存在作为自变量，对移植物存活率进行多变量分析。60%的受者为黑人，82%为初次移植；28个肾脏（12%）来自黑人供体。112例供受者种族相同的患者与124例供受者种族不同的患者的5年移植物存活率相同（40%；P = 0.1726）。88例接受白人供体器官的白人受者的5年存活率高于120例接受白人供体器官的黑人受者（分别为54%和42%；P = 0.0398）。无论器官来源如何，黑人受者（半衰期= 37个月）的情况都比白人受者（半衰期= 60个月）差（P = 0.023）。在多变量分析中，供体和受者的种族都不是预测移植物存活率的独立变量。排斥反应（相对风险= 2.9）和移植入院时的透析需求（相对风险= 4.1）是预测存活率低的唯一因素。黑人受者的排斥反应更多（P = 0.04），但无论供体种族如何，移植后透析需求并未增加。在本系列中，供体种族不影响移植物存活率。受者种族对移植物存活率的影响是由于黑人受者排斥反应发生率增加，这与HLA错配无关。这些数据表明，需要改善免疫抑制，而不是改变分配方式，来提高移植物存活率。
