RENAL TRANSPLANTATION IN AFRICAN AMERICANS

非裔美国人的肾移植

• 批准号: 2147642
• 负责人: YOULIAN LIAO
• 金额: $ 4.99万
• 依托单位: LOYOLA UNIVERSITY CHICAGO
• 依托单位国家: 美国
• 财政年份: 1994
• 资助国家: 美国
• 起止时间: 1994-03-15 至 1996-02-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/2147642
• 关键词: African American; age difference; artificial immunosuppression; chronic renal failure; computer simulation; gender difference; histocompatibility; human data; kidney transplantation; patient care; racial /ethnic difference

In the U.S. the relative risk of end-stage renal disease (ESRD) is about fourfold higher for blacks than whites. Blacks represent an increasing proportion of patients maintained with renal replacement therapy. The number of renal transplantations increased two-fold in the past decade for both blacks and whites. However, as compared with whites, there are few studies of renal transplantation among blacks. We propose to analyze data from the USRDS to examine: Trends of renal transplantation as the treatment modality for ESRD" black and white comparison. As compared with whites, a smaller percentage of black patients on dialysis have undergone renal transplantation. The secular trends of this gap from 1977 to 1990 and in three times periods (1977-1982, 1983-1986, and 1987-1990_ will be examined. Secular trends of some demographic characteristics such as age, sex, and primary diseases causing ESRD, will also examined to see if they account for these racial trend differences. HLA typing and matching in blacks. In the U.S. blacks wait almost twice as long for a first transplant as do whites. Sine the HLA matching is heavily weighted as a criterion for kidney allocation, the impact of HLA frequency differences between races will be examined. Based on these data, a computer simulation will be performed to estimate the racial differences in obtaining various degrees of HLA matching for various recipient pool sizes. These analyses will permit us to further understand the effect of race on access to donor kidneys in renal transplantation. Outcome of renal transplantation in blacks. The role that both donor and recipient race plays in the success of a kidney transplant has been the subject of considerable debate. In this study the early graft function (early post transplant dialysis and rejection) as well as short- and long-term graft survival will be compared between blacks and whites. The effects of the following factors on racial differences in outcome will be examined: center effects, HLA matching, immunosuppression regimens, primary diseases causing ESRD, sensitization, blood transfusion, kidney ischemia time, donor and recipient sex and age. Effect of HLA matching on graft survival in blacks. The impact of HLA matching on graft survival in blacks will be investigated and compared to whites. Using proportional hazards modelling several questions will be investigated: Whether there is an association between HLA matching and graft survival in blacks and whether the impact of HLA matching is the same for blacks as for whites. Whether the impact of HLA matching as characterized by the number of mismatches determines a graded or a threshold effect on graft survival. Finally, which or in what kinds of combinations of A, B, and DR mismatches would better predict graft outcomes in blacks.

在美国，终末期肾脏疾病（ESRD）的相对风险大约 黑人比白人高四倍。 黑人代表越来越多的 维持肾脏替代疗法的患者比例。这 在过去的十年中，肾脏移植数量增加了两倍 对于黑人和白人。 但是，与白人相比， 很少有黑人肾脏移植的研究。 我们建议分析 来自USRD的数据检查： 肾移植作为ESRD的治疗方式的趋势“黑色 和白色比较。 与白人相比，较小的百分比 透析的黑人患者接受了肾移植。 这 从1977年到1990年和三个时期内的这一差距的世俗趋势 （1977-1982，1983-1986和1987-1990_将进行检查。世俗趋势 在某些人口统计学特征（例如年龄，性别和主要） 引起ESRD的疾病还将检查以查看它们是否解释 这些种族趋势差异。 HLA打字并匹配黑色。 在美国黑人几乎等待两次 与白人一样长。 正弦HLA匹配是 重量重量作为肾脏分配的标准，HLA的影响 将检查种族之间的频率差异。 基于这些 数据，将进行计算机模拟以估计种族 获得各种HLA匹配的各种程度的差异 收件人池尺寸。 这些分析将使我们能够进一步 了解种族对肾脏供体肾脏的访问的影响 移植。 黑人肾脏移植的结果。 捐助者和 接受者竞赛在肾脏移植的成功中发挥了作用 大量辩论的主题。 在这项研究中，早期移植功能 （早期移植后透析和排斥）以及短期和短暂的 黑人和白人之间将比较长期的移植生存。 这 以下因素对结果差异的影响将 被检查：中心效应，HLA匹配，免疫抑制方案， 导致ESRD，致敏，输血，肾脏的原发性疾病 缺血时间，捐助者和接受者的性和年龄。 HLA匹配对黑人移植生存的影响。 HLA的影响 将研究并进行比较 到白人。 使用比例危害建模几个问题将 被调查：HLA匹配与 嫁接在黑人中的生存以及HLA匹配的影响是否是 黑人和白人一样。 HLA匹配的影响是否为 以不匹配的数量为特征确定分级或 阈值对移植物存活的影响。 最后，哪种或哪种 A，B和DR不匹配的组合可以更好地预测移植物 黑人的结果。