Park K T, Nanda Pranav, Bensen Rachel, Strichartz Debra, Esquivel Carlos, Cox Kenneth
Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Stanford University Medical Center, Lucile Packard Children's Hospital, Palo Alto, CA, USA.
Pediatr Transplant. 2011 May;15(3):300-5. doi: 10.1111/j.1399-3046.2010.01452.x. Epub 2011 Mar 30.
Rural status of patients may impact health before and after pediatric LT. We used UI codes published by the USDA to stratify patients as urban or rural depending county residence. A total of 388 patients who had LT and who met criteria were included. Rejection, PTLD, and survival were used as primary outcome measures of post-LT health. UNOS Status 1 and PELD/MELD scores >20 were used as secondary outcome measures of poorer pre-LT health. Logistic regression models were run to determine associations. We did not find any statistically significant differences in pre- or post-LT outcomes with respect to rurality. Among rural patients, there was a general trend for decreased incidence of rejection (25.0% vs. 33.4%; OR 0.64, 95% CI 0.29-1.44), increased risk of PTLD (5.6% vs. 3.4%; OR 1.86, 95% CI 0.36-3.31), and decreased survival (OR 0.85, 95% CI 0.34-2.13) after LT. Rural patients also tended to be sicker at the time of LT than patients from urban areas, with increased proportion of Status 1 (OR 1.17, 95% CI 0.51-2.70) and PELD/MELD scores >20 (OR 1.20, 95% CI 0.59-2.45). From a single center experience, we conclude that rurality did not significantly affect health outcomes after LT, although a larger study may validate the general trends that rural patients may have decreased rejection, increased PTLD, and mortality, and be in poorer health at the time of LT.
患者的农村身份可能会在小儿肝移植前后影响健康。我们使用美国农业部公布的统一识别码，根据患者所在县的居住地将其分为城市或农村患者。共有388例接受肝移植且符合标准的患者被纳入研究。排斥反应、移植后淋巴细胞增生性疾病（PTLD）和生存率被用作肝移植后健康状况的主要结局指标。器官共享联合网络（UNOS）1级状态以及儿科终末期肝病评分（PELD）/终末期肝病模型评分（MELD）>20被用作肝移植前健康状况较差的次要结局指标。运用逻辑回归模型来确定相关性。我们没有发现农村身份在肝移植前后的结局方面存在任何统计学上的显著差异。在农村患者中，肝移植后排斥反应发生率降低（25.0%对33.4%；比值比[OR]0.64，95%置信区间[CI]0.29 - 1.44）、PTLD风险增加（5.6%对3.4%；OR 1.86，95% CI 0.36 - 3.31）以及生存率降低（OR 0.85，95% CI 0.34 - 2.13）存在总体趋势。农村患者在肝移植时也往往比城市地区的患者病情更重，1级状态的比例增加（OR 1.17，95% CI 0.51 - 2.70）以及PELD/MELD评分>20的比例增加（OR 1.20，95% CI 0.59 - 2.45）。从单一中心的经验来看，我们得出结论，农村身份在肝移植后并未显著影响健康结局，尽管更大规模的研究可能会证实农村患者可能出现排斥反应降低、PTLD增加以及死亡率增加且在肝移植时健康状况较差的总体趋势。
