Service de Pneumologie B et Transplantation Pulmonaire, Hôpital Bichat, Paris, France.
Am J Transplant. 2012 Nov;12(11):3085-93. doi: 10.1111/j.1600-6143.2012.04202.x. Epub 2012 Aug 6.
The 62 lung transplant centers in the United States are unevenly distributed. We examined whether remote dwelling (distance from one's primary residence to the nearest lung transplant center) or rural dwelling (as opposed to urban) influences patients' access to lung transplantation, and whether such relationships changed following introduction of the lung allocation score (LAS) in May 2005. Between July 2001 and February 2009, 14 015 patients were listed for lung transplantation and 7923 (56.5%) were transplanted. Americans lived a median of 90.3 miles (IQR: 45.3-159.4) from the closest transplant center. Distance from a lung transplant center was inversely associated with the hazard of being listed before LAS implementation (adjusted HR for 100 miles = 0.87 [0.83-0.90]) and afterward (0.81 [0.78-0.85]); LAS implementation did not modify this relationship (p = 0.38). Once waitlisted, distance from the closest center was not associated with time to transplantation, and among those transplanted, distance was not associated with survival. Similar results were identified for rural, as opposed to urban, residence. We conclude that geographic disparaties exist in access to lung transplantation in the United States. These are mediated by listing practices rather than by transplantation rates, and were not mitigated by LAS implementation.
美国的 62 个肺移植中心分布不均。我们研究了居住地点偏远（距离患者常住地到最近的肺移植中心的距离）或居住在农村（与城市相对）是否会影响患者接受肺移植的机会，以及在 2005 年 5 月引入肺分配评分（LAS）后，这些关系是否发生了变化。2001 年 7 月至 2009 年 2 月，共有 14015 名患者接受了肺移植登记，其中 7923 名（56.5%）接受了肺移植。美国人距离最近的移植中心的中位数距离为 90.3 英里（IQR：45.3-159.4）。距离肺移植中心的距离与 LAS 实施前（调整后的 HR 为 100 英里=0.87[0.83-0.90]）和之后（0.81[0.78-0.85]）被列入名单的风险呈反比；LAS 的实施并没有改变这种关系（p=0.38）。一旦被列入等待名单，距离最近的中心与移植时间无关，而在接受移植的患者中，距离与存活率无关。农村与城市的居住情况也有类似的结果。我们的结论是，美国的肺移植机会存在地域差异。这些差异是通过列入名单的做法而不是通过移植率来调节的，并且 LAS 的实施并没有减轻这些差异。
