Tesi R J, Deboisblanc M, Saul C, Frentz G, Etheredge E
Tulane University Medical Center, New Orleans, La., USA.
Arch Surg. 1997 Jan;132(1):35-9; discussion 40. doi: 10.1001/archsurg.1997.01430250037007.
To evaluate the cause of worse kidney allograft survival in black recipients, which has been the source of considerable interest and debate.
Three hundred ninety-two consecutive renal allografts (O HLA mismatch grafts excluded) were reviewed. Of the recipients, 57% were black, 27% received living donor grafts, and 86% received their first transplant. All recipients underwent an oral cyclosporine induction protocol with triple drug maintenance. Crude graft survival, the risk of rejection, and the need for dialysis were determined using donor and recipient demographic and immunologic variables.
Graft survival was 84%, 67%, and 50% at 1, 3, and 5 years after the transplantation, respectively. The survival of black recipients was 4%, 11%, and 20% worse than that of white recipients at 1, 3, and 5 years, respectively (P < .002). When only pretransplantation variables were considered, black recipient race was the only variable that predicted graft loss in the multivariate analysis (relative risk [RR] = 1.6, P = .09). When posttransplantation and pretransplantation variables were used, cadaver donor (RR = 1.7), an episode of rejection (RR = 2.6), and the need for dialysis (RR = 2.7) were independent variables that predicted graft loss (P < .001). Black recipient race was a dependent variable. Four pretransplantation variables predicted the risk of dialysis: black race (RR = 3.6), male recipient (RR = 2.1), cadaveric donor (RR = 2.2), and a peak panel-reactive antibody level greater than 30% (RR = 2.8). Three pretransplantation variables predicted the risk of rejection: black race (RR = 1.7), male recipient (RR = 1.6), and a current panel-reactive antibody level greater than 30% (RR = 5.3).
These data suggest that black recipient race is a dependent predictor of renal allograft survival when the posttransplantation events of rejection and dialysis are considered. Black recipients have more immunologic complications after renal transplantation that result in worse graft survival. These results confirm the importance of postallograft events as the major determinants of long-term graft survival and suggest that black recipients are receiving inadequate immunosuppression. These data support attempts to tailor immunosuppressive protocols to recipient pretransplantation risk profiles as a way to improve graft survival in the high-risk recipient.
评估黑人受者肾移植存活率较低的原因，这一问题一直备受关注且存在争议。
回顾了392例连续的肾移植病例（排除O型 HLA错配移植）。受者中，57%为黑人，27%接受活体供肾移植，86%接受首次移植。所有受者均采用口服环孢素诱导方案并维持三联药物治疗。利用供者和受者的人口统计学及免疫学变量来确定粗移植存活率、排斥反应风险及透析需求。
移植后1年、3年和5年的移植存活率分别为84%、67%和50%。黑人受者在1年、3年和5年时的存活率分别比白人受者低4%、11%和20%（P <.002）。仅考虑移植前变量时，在多因素分析中黑人受者种族是唯一预测移植肾丢失的变量（相对风险[RR]=1.6，P =.09）。当同时使用移植后和移植前变量时，尸体供肾（RR = 1.7）、一次排斥反应发作（RR = 2.6）及透析需求（RR = 2.7）是预测移植肾丢失的独立变量（P <.001）。黑人受者种族是一个因变量。四个移植前变量可预测透析风险：黑人种族（RR = 3.6）、男性受者（RR = 2.1）、尸体供者（RR = 2.2）及群体反应性抗体峰值水平大于30%（RR = 2.8）。三个移植前变量可预测排斥反应风险：黑人种族（RR = 1.7）、男性受者（RR = 1.6）及当前群体反应性抗体水平大于30%（RR = 5.3）。
这些数据表明，当考虑到移植后排斥反应和透析等事件时，黑人受者种族是肾移植存活率的一个因变量预测因素。黑人受者肾移植后有更多免疫并发症，导致移植存活率更低。这些结果证实了移植后事件作为长期移植存活主要决定因素的重要性，并表明黑人受者免疫抑制不足。这些数据支持根据受者移植前风险特征调整免疫抑制方案，以提高高危受者移植存活率的尝试。
