Abstract：
Racial and ethnic disparities in pediatric lung transplantation (LTx) related to the shifting cystic fibrosis (CF) population receiving highly effective modulator therapy (HEMT) has not been well investigated.
The UNOS Registry was queried for patients age 1-25 years undergoing bilateral LTx between 1 January 2012 and 31 December 2021. Race and ethnicity were classified as non-Hispanic White, non-Hispanic Black, Hispanic, or none of the above. The primary outcome was posttransplant mortality. Trends in the association between race/ethnicity and mortality were examined using transplant year as a continuous variable and stratifying year based on introduction of HEMT (triple combination therapy) in November 2019.
In the study sample (N = 941), 7% of patients were non-Hispanic Black, 15% were Hispanic, and 2% were some other racial or ethnic group. One hundred (11%) received LTx after approval of triple combination therapy, and 407 (43%) died during follow-up. We identified a statistically significant disparity in mortality hazard (hazard ratio: 1.91; 95% confidence interval: 1.31, 2.80) in non-Hispanic Black compared to non-Hispanic White patients in the pre-triple combination therapy era.
We found higher mortality hazard among non-Hispanic Black compared to non-Hispanic White children undergoing LTx in the United States. Further monitoring of LTx outcomes to identify and address disparities is needed in the current era of triple combination therapy for CF.
The UNOS Registry was queried for patients age 1-25 years undergoing bilateral LTx between 1 January 2012 and 31 December 2021. Race and ethnicity were classified as non-Hispanic White, non-Hispanic Black, Hispanic, or none of the above. The primary outcome was posttransplant mortality. Trends in the association between race/ethnicity and mortality were examined using transplant year as a continuous variable and stratifying year based on introduction of HEMT (triple combination therapy) in November 2019.
In the study sample (N = 941), 7% of patients were non-Hispanic Black, 15% were Hispanic, and 2% were some other racial or ethnic group. One hundred (11%) received LTx after approval of triple combination therapy, and 407 (43%) died during follow-up. We identified a statistically significant disparity in mortality hazard (hazard ratio: 1.91; 95% confidence interval: 1.31, 2.80) in non-Hispanic Black compared to non-Hispanic White patients in the pre-triple combination therapy era.
We found higher mortality hazard among non-Hispanic Black compared to non-Hispanic White children undergoing LTx in the United States. Further monitoring of LTx outcomes to identify and address disparities is needed in the current era of triple combination therapy for CF.
摘要：
背景：儿童肺移植（LTx）中与接受高效调节治疗（HEMT）的囊性纤维化（CF）人群相关的种族和种族差异尚未得到很好的研究。
方法：在2012年1月1日至2021年12月31日期间，查询UNOS登记处1-25岁接受双侧LTx的患者。种族和种族被归类为非西班牙裔白人，非西班牙裔黑人,西班牙裔,或者以上都没有。主要结果是移植后死亡率。根据2019年11月引入HEMT（三联疗法），使用移植年作为连续变量和分层年检查了种族/民族与死亡率之间的关联趋势。
结果：在研究样本中（N=941），7%的患者是非西班牙裔黑人，15%是西班牙裔,2%是其他种族或族裔。一百（11％）在批准三联疗法后接受LTx，随访期间死亡407人（43%）。我们发现，在三联疗法前，非西班牙裔黑人与非西班牙裔白人患者的死亡率风险（风险比：1.91；95％置信区间：1.31，2.80）存在统计学差异。
结论：我们发现在美国接受LTx治疗的非西班牙裔黑人儿童死亡率高于非西班牙裔白人儿童。在CF三联疗法的当前时代，需要进一步监测LTx结果以识别和解决差异。
方法：在2012年1月1日至2021年12月31日期间，查询UNOS登记处1-25岁接受双侧LTx的患者。种族和种族被归类为非西班牙裔白人，非西班牙裔黑人,西班牙裔,或者以上都没有。主要结果是移植后死亡率。根据2019年11月引入HEMT（三联疗法），使用移植年作为连续变量和分层年检查了种族/民族与死亡率之间的关联趋势。
结果：在研究样本中（N=941），7%的患者是非西班牙裔黑人，15%是西班牙裔,2%是其他种族或族裔。一百（11％）在批准三联疗法后接受LTx，随访期间死亡407人（43%）。我们发现，在三联疗法前，非西班牙裔黑人与非西班牙裔白人患者的死亡率风险（风险比：1.91；95％置信区间：1.31，2.80）存在统计学差异。
结论：我们发现在美国接受LTx治疗的非西班牙裔黑人儿童死亡率高于非西班牙裔白人儿童。在CF三联疗法的当前时代，需要进一步监测LTx结果以识别和解决差异。
