Nobel Yael R, Forde Kimberly A, Wood Linda, Cartiera Katarzyna, Munoz-Abraham Armando S, Yoo Peter S, Abt Peter L, Goldberg David S
Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
Division of Gastroenterology, Department of Medicine, University of Pennsylvania, Philadelphia, PA.
Liver Transpl. 2015 Jul;21(7):904-13. doi: 10.1002/lt.24147. Epub 2015 Jun 9.
Living donor liver transplantation (LDLT) is a comparable alternative to deceased donor liver transplantation and can mitigate the risk of dying while waiting for transplant. Although evidence exists of decreased utilization of living donor kidney transplants among racial minorities, little is known about access to LDLT among racial/ethnic minorities. We used Organ Procurement and Transplantation Network/United Network for Organ Sharing data from February 27, 2002 to June 4, 2014 from all adult liver transplant recipients at LDLT-capable transplant centers to evaluate differential utilization of LDLTs based on race/ethnicity. We then used data from 2 major urban transplant centers to analyze donor inquiries and donor rule-outs based on racial/ethnic determination. Nationally, of 35,401 total liver transplant recipients performed at a LDLT-performing transplant center, 2171 (6.1%) received a LDLT. In multivariate generalized estimating equation models, racial/ethnic minorities were significantly less likely to receive LDLTs when compared to white patients. For cholestatic liver disease, the odds ratios of receiving LDLT based on racial/ethnic group for African American, Hispanic, and Asian patients compared to white patients were 0.35 (95% CI, 0.20-0.60), 0.58 (95% CI, 0.34-0.99), and 0.11 (95% CI, 0.02-0.55), respectively. For noncholestatic liver disease, the odds ratios by racial/ethnic group were 0.53 (95% CI, 0.40-0.71), 0.78 (95% CI, 0.64-0.94), and 0.45 (95% CI, 0.33-0.60) respectively. Transplant center-specific data demonstrated that African American patients received fewer per-patient donation inquiries than white patients, whereas fewer African American potential donors were ruled out for obesity. In conclusion, racial/ethnic minorities receive a disproportionately low percentage of LDLTs, due in part to fewer initial inquiries by potential donors. This represents a major inequality in access to a vital health care resource and demands outreach to both patients and potential donors.
活体供肝移植（LDLT）是尸体供肝移植的一种可比较的替代方案，能够降低等待移植期间死亡的风险。虽然有证据表明少数族裔活体供肾移植的利用率有所下降，但对于少数族裔获得LDLT的情况却知之甚少。我们使用了器官获取与移植网络/器官共享联合网络2002年2月27日至2014年6月4日的数据，这些数据来自有能力进行LDLT的移植中心的所有成年肝移植受者，以评估基于种族/族裔的LDLT差异利用情况。然后，我们使用了两个主要城市移植中心的数据，来分析基于种族/族裔判定的供体咨询和供体排除情况。在全国范围内，在有能力进行LDLT的移植中心进行的35401例肝移植受者中，有2171例（6.1%）接受了LDLT。在多变量广义估计方程模型中，与白人患者相比，少数族裔接受LDLT的可能性显著降低。对于胆汁淤积性肝病，非裔美国人、西班牙裔和亚裔患者与白人患者相比，接受LDLT的比值比分别为0.35（95%CI，0.20 - 0.60）、0.58（95%CI，0.34 - 0.99）和0.11（95%CI，0.02 - 0.55）。对于非胆汁淤积性肝病，按种族/族裔分组的比值比分别为0.53（95%CI，0.40 - 0.71）、0.78（95%CI，0.64 - 0.94）和0.45（95%CI，0.33 - 0.60）。特定移植中心的数据表明，非裔美国患者收到的每位患者捐赠咨询比白人患者少，而因肥胖被排除的非裔美国潜在供体较少。总之，少数族裔接受LDLT的比例低得不成比例，部分原因是潜在供体的初始咨询较少。这代表了在获取重要医疗资源方面的重大不平等，需要对患者和潜在供体进行宣传推广。
