Regional Disparities in Kidney Transplant Allocation in Brazil: A Retrospective Cohort Study

IF 1.9 4区医学 Q2 SURGERY Clinical Transplantation Pub Date : 2024-08-30 DOI:10.1111/ctr.15446

Daniela Ferreira Salomão Pontes, Gustavo Fernandes Ferreira, Dorry Segev, Allan B. Massie, Macey Levan, Abner Mácola Pacheco Barbosa, Naila Camila da Rocha, Luis Gustavo Modelli de Andrade

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Abstract

Background

Brazil has a large public transplant program, but it remains unclear if the kidney waitlist criteria effectively allocate organs. This study aimed to investigate whether gender, ethnicity, clinical characteristics, and Brazilian regions affect the chance of deceased donor kidney transplant (DDKT).

Methods

We conducted a retrospective cohort study using the National Transplant System/Brazil database, which included all patients on the kidney transplant waitlist from January 2012 to December 2022, followed until May 2023. The primary outcome assessed was the chance of DDKT, measured using subdistribution hazard and cause-specific hazard models (subdistribution hazard ratio [sHR]).

Results

We analyzed 118 617 waitlisted patients over a 10-year study period. Male patients had an sHR of 1.07 ([95% CI: 1.05–1.10], p < 0.001), indicating a higher chance of DDTK. Patients of mixed race and Yellow/Indigenous ethnicity had lower rates of receiving a transplant compared to Caucasian patients, with sHR of 0.97 (95% CI: 0.95–1) and 0.89 (95% CI: 0.95–1), respectively. Patients from the South region had the highest chance of DDKT, followed by those from the Midwest and Northeast, compared to patients from the Southeast, with sHR of 2.53 (95% CI: 2.47–2.61), 1.21 (95% CI: 1.16–1.27), and 1.10 (95% CI: 1.07–1.13), respectively. The North region had the lowest chance of DDTK, sHR of 0.29 (95% CI: 0.27–0.31).

Conclusion

We found that women and racial minorities faced disadvantages in kidney transplantation. Additionally, we observed regional disparities, with the North region having the lowest chance of DDKT and longer times on dialysis before being waitlisted. In contrast, patients in the South regions had a chance of DDKT and shorter times on dialysis before being waitlisted. It is urgent to implement approaches to enhance transplant capacity in the North region and address race and gender disparities in transplantation.

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巴西肾移植分配的地区差异：回顾性队列研究

背景巴西有一个庞大的公共移植项目，但肾脏等待名单标准是否能有效分配器官仍不清楚。本研究旨在探讨性别、种族、临床特征和巴西地区是否会影响死亡供体肾移植（DDKT）的机会。方法我们利用巴西国家移植系统数据库（National Transplant System/Brazil database）进行了一项回顾性队列研究，该数据库包括从 2012 年 1 月至 2022 年 12 月肾移植等待者名单上的所有患者，并跟踪至 2023 年 5 月。评估的主要结果是 DDKT 的几率，采用亚分布危险模型和特定病因危险模型（亚分布危险比 [sHR]）进行测量。结果我们对 10 年研究期间的 118 617 名候补患者进行了分析。男性患者的亚分布危险比为 1.07（[95% CI：1.05-1.10]，p < 0.001），表明 DDTK 的几率更高。与白种人相比，混血儿和黄种人/土著人接受移植的几率较低，sHR 分别为 0.97（95% CI：0.95-1）和 0.89（95% CI：0.95-1）。与来自东南部的患者相比，来自南部地区的患者发生 DDKT 的几率最高，其次是来自中西部和东北部的患者，sHR 分别为 2.53（95% CI：2.47-2.61）、1.21（95% CI：1.16-1.27）和 1.10（95% CI：1.07-1.13）。北部地区出现 DDTK 的几率最低，sHR 为 0.29（95% CI：0.27-0.31）。结论我们发现，女性和少数种族在肾移植中处于不利地位。此外，我们还观察到地区间的差异，北部地区的 DDKT 机率最低，在列入等待名单之前的透析时间较长。与此相反，南部地区患者的 DDKT 机率较高，等待肾移植之前的透析时间较短。当务之急是采取措施提高北部地区的移植能力，并解决移植中的种族和性别差异问题。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Transplantation 医学-外科

CiteScore

3.70

自引率

4.80%

发文量

286

审稿时长

2 months

期刊介绍： Clinical Transplantation: The Journal of Clinical and Translational Research aims to serve as a channel of rapid communication for all those involved in the care of patients who require, or have had, organ or tissue transplants, including: kidney, intestine, liver, pancreas, islets, heart, heart valves, lung, bone marrow, cornea, skin, bone, and cartilage, viable or stored. Published monthly, Clinical Transplantation’s scope is focused on the complete spectrum of present transplant therapies, as well as also those that are experimental or may become possible in future. Topics include: Immunology and immunosuppression; Patient preparation; Social, ethical, and psychological issues; Complications, short- and long-term results; Artificial organs; Donation and preservation of organ and tissue; Translational studies; Advances in tissue typing; Updates on transplant pathology;. Clinical and translational studies are particularly welcome, as well as focused reviews. Full-length papers and short communications are invited. Clinical reviews are encouraged, as well as seminal papers in basic science which might lead to immediate clinical application. Prominence is regularly given to the results of cooperative surveys conducted by the organ and tissue transplant registries. Clinical Transplantation: The Journal of Clinical and Translational Research is essential reading for clinicians and researchers in the diverse field of transplantation: surgeons; clinical immunologists; cryobiologists; hematologists; gastroenterologists; hepatologists; pulmonologists; nephrologists; cardiologists; and endocrinologists. It will also be of interest to sociologists, psychologists, research workers, and to all health professionals whose combined efforts will improve the prognosis of transplant recipients.