Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Lucile Packard Children's Hospital at Stanford, Palo Alto, CA 94304, USA.
J Pediatr. 2013 Feb;162(2):313-8.e1. doi: 10.1016/j.jpeds.2012.07.015. Epub 2012 Aug 20.
To determine whether children in rural areas have worse health than children in urban areas after liver transplantation (LT).
We used urban influence codes published by the US Department of Agriculture to categorize 3307 pediatric patients undergoing LT in the United Network of Organ Sharing database between 2004 and 2009 as urban or rural. Allograft rejection, patient death, and graft failure were used as primary outcome measures of post-LT health. Pediatric end-stage liver disease/model of end-stage liver disease scores >20 was used to measure worse pre-LT health.
In a multivariate analysis, we found greater rates of allograft rejection within 6 months of LT (OR 1.27; 95% CI 1.05-1.53) and a lower occurrence of posttransplantation lymphoproliferative disorder (OR 0.64; 95% CI 0.41-0.99) in patients in rural areas. The difference in allograft rejection was eliminated at 1 year of LT (OR 1.18; 95% CI 0.98-1.42). Rural location did not impact other outcome measures.
We conclude that rural location makes a negative impact on patient health within the first 6 months of LT by increasing the risk for allograft rejection, although patients in rural areas may have lower rates of developing posttransplantation lymphoproliferative disorder. Long-term adverse health effects were not seen.
确定在肝移植（LT）后，农村地区儿童的健康状况是否比城市地区儿童差。
我们使用美国农业部公布的城市影响代码，将 2004 年至 2009 年期间在美国器官共享网络数据库中接受 LT 的 3307 名儿科患者分为城市或农村。同种异体排斥、患者死亡和移植物衰竭被用作 LT 后健康的主要结局指标。小儿终末期肝病/终末期肝病模型评分>20 用于衡量 LT 前较差的健康状况。
在多变量分析中，我们发现农村地区患者在 LT 后 6 个月内同种异体排斥的发生率更高（OR 1.27；95%CI 1.05-1.53），移植后淋巴组织增生性疾病的发生率较低（OR 0.64；95%CI 0.41-0.99）。LT 后 1 年，同种异体排斥的差异消除（OR 1.18；95%CI 0.98-1.42）。农村地区的位置并不影响其他结局指标。
我们的结论是，农村地区的位置在 LT 的前 6 个月内对患者的健康产生负面影响，增加了同种异体排斥的风险，尽管农村地区的患者可能发生移植后淋巴组织增生性疾病的风险较低。长期不良健康影响并未出现。
