Persistent Link:
http://hdl.handle.net/10150/315930
Title:
First Kidney Allograft Mismatch and Survival in American Indians
Author:
Thomsen, Chelsea
Affiliation:
The University of Arizona College of Medicine - Phoenix
Issue Date:
Apr-2014
Rights:
Copyright © is held by the author. Digital access to this material is made possible by the College of Medicine - Phoenix, University of Arizona. Further transmission, reproduction or presentation (such as public display or performance) of protected items is prohibited except with permission of the author.
Collection Information:
This item is part of the College of Medicine - Phoenix Scholarly Projects 2014 collection. For more information, contact the Phoenix Biomedical Campus Library at pbc-library@email.arizona.edu.
Publisher:
The University of Arizona.
Abstract:
Over 121,000 individuals are awaiting renal allograft in the United States.1 This ongoing imbalance of supply and demand has made research aiming to improve renal allograft survival a necessity. Details of the collection, distribution, and outcomes of renal allografts found in the United Network for Organ Sharing (UNOS) database were used in a retrospective study to identify and evaluate differences in allograft survival between American Indians and other heritage groups. In particular, the study aimed to identify whether American Indians have a similar distribution of HLA mismatches between recipient and donor when compared to other populations; and whether this impacts overall kidney allograft survival. Contingency table and Cox Regression analyses were applied and found that the Hazard Ratio was greater than 1 for all mismatches; and furthermore, an increase in mismatches was proportional to an increase in hazard ratio that was statistically significant. Recipients with 4, 5, or 6 mismatches showed a hazard ratio of 1.466 (p<0.0564). The HLA-DR allele has been known historically as the most important locus for transplants.2 Better matching, particularly at the DR locus, results in improved kidney survival time. Additionally, age, gender, and transplant era were used as major covariates in allograft survival using a proportional hazards model. Increasing age of recipient is associated with increased kidney survival time, and female gender is associated with decreased kidney survival time. Transplant era had a very high Chi-Square of 40.22 and an overall 5% increased survival with most recent transplants living longer than older era transplants. These results have implications for potential policy changes regarding organ allocation in addition to identifying an increased need in organ donation within specific heritage groups.
MeSH Subjects:
Allografts; Kidney; Indians, North American
Description:
A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine.
Mentor:
Chakkera, Harini MD; Williams, Robert PhD

Full metadata record

DC FieldValue Language
dc.language.isoen_USen
dc.titleFirst Kidney Allograft Mismatch and Survival in American Indiansen_US
dc.contributor.authorThomsen, Chelseaen_US
dc.contributor.departmentThe University of Arizona College of Medicine - Phoenixen_US
dc.date.issued2014-04-
dc.rightsCopyright © is held by the author. Digital access to this material is made possible by the College of Medicine - Phoenix, University of Arizona. Further transmission, reproduction or presentation (such as public display or performance) of protected items is prohibited except with permission of the author.en_US
dc.description.collectioninformationThis item is part of the College of Medicine - Phoenix Scholarly Projects 2014 collection. For more information, contact the Phoenix Biomedical Campus Library at pbc-library@email.arizona.edu.en_US
dc.publisherThe University of Arizona.en_US
dc.description.abstractOver 121,000 individuals are awaiting renal allograft in the United States.1 This ongoing imbalance of supply and demand has made research aiming to improve renal allograft survival a necessity. Details of the collection, distribution, and outcomes of renal allografts found in the United Network for Organ Sharing (UNOS) database were used in a retrospective study to identify and evaluate differences in allograft survival between American Indians and other heritage groups. In particular, the study aimed to identify whether American Indians have a similar distribution of HLA mismatches between recipient and donor when compared to other populations; and whether this impacts overall kidney allograft survival. Contingency table and Cox Regression analyses were applied and found that the Hazard Ratio was greater than 1 for all mismatches; and furthermore, an increase in mismatches was proportional to an increase in hazard ratio that was statistically significant. Recipients with 4, 5, or 6 mismatches showed a hazard ratio of 1.466 (p<0.0564). The HLA-DR allele has been known historically as the most important locus for transplants.2 Better matching, particularly at the DR locus, results in improved kidney survival time. Additionally, age, gender, and transplant era were used as major covariates in allograft survival using a proportional hazards model. Increasing age of recipient is associated with increased kidney survival time, and female gender is associated with decreased kidney survival time. Transplant era had a very high Chi-Square of 40.22 and an overall 5% increased survival with most recent transplants living longer than older era transplants. These results have implications for potential policy changes regarding organ allocation in addition to identifying an increased need in organ donation within specific heritage groups.en_US
dc.typeThesisen
dc.subject.meshAllograftsen_US
dc.subject.meshKidneyen_US
dc.subject.meshIndians, North Americanen_US
dc.descriptionA Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine.en_US
dc.contributor.mentorChakkera, Harini MDen_US
dc.contributor.mentorWilliams, Robert PhDen_US
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