| Popis: |
Background: Race has been proposed to be associated with graft survival after pancreas transplantation (PTx). African-American (AA) recipients, as well as those with AA donors, always experience worse graft survival than other racial groups. We hypothesize that the racial disparity may disappear in modern times. Methods: We analyzed data from the Scientific Registry of Transplant Recipients (January 1989 - August 2018). Using Kaplan-Meier estimation and Cox proportional hazards regression, we examined the impact of race on pancreatic graft survival after PTx. Findings: A total of 28797 pancreatic recipients were included in final analysis, including 22430 Whites, 3828 AAs, 2235 Hispanics, and 304 Asians, and 71.6% of donors came from Whites, 15.1% from AAs, 11.8% from Hispanics, and 1.6% from Asians. After 3 years of follow-up evaluation, there were 6903 pancreatic grafts failed (PGF). Before 2009, AA recipients (hazard ratio [HR], 1.34; 95% confidence interval [CI], 1.10-1.64) were associated with PGF after adjusting confounding factors, and risk of PGF for White and Asian recipients were both comparable with Hispanic counterparts. However, the risk of PGF in AA recipients decreased to 2% and was no longer significant since 2009 (HR, 1.02; 95% CI, 0.77-1.34). Interestingly, donor race had the similar results as recipient race. Furthermore, the concordance statistic of the complete pancreas donor risk index (PDRI) (including donor race) was 0.582, whereas the concordance did not change when the donor race was eliminated from the PDRI model (0.580). Interpretation: With the potent immunosuppressive regimen and improved surgical techniques in recent era, AA and other racial recipients had similar pancreatic graft outcomes. Furthermore, racial disparity of donor also could be neutralized, so donor race should not be considered as an indicator of donor quality. Funding: Natural Science Foundation of Zhejiang, National Natural Science Foundation, Scientific Research Project of Education of Zhejiang. Ethical Approval Statement: The whole study was reviewed and approved by the ethics committee at Zhejiang University, China. Competing Interest Declaration: The authors of this manuscript have no conflicts of interest to disclose. |
