Croome Kristopher P, Lee David D, Burns Justin M, Perry Dana K, Keaveny Andrew P, Taner C Burcin
Mayo Clinic Collaborative in Transplant Research and Outcomes, Department of Transplant, Mayo Clinic, Jacksonville Florida.
PLoS One. 2015 Oct 15;10(10):e0140295. doi: 10.1371/journal.pone.0140295. eCollection 2015.
Traveling to seek specialized care such as liver transplantation (LT) is a reality in the United States. Patient migration has been attributed to organ availability. The aims of this study were to delineate patterns of patient migration and outcomes after LT.
All deceased donor LT between 2008-2013 were extracted from UNOS data. Migrated patients were defined as those patients who underwent LT at a center in a different UNOS region from the region in which they resided and traveled a distance > 100 miles.
Migrated patients comprised 8.2% of 28,700 LT performed. Efflux and influx of patients were observed in all 11 UNOS regions. Regions 1, 5, 6, and 9 had a net efflux, while regions 2, 3, 4, 7, 10, and 11 had a net influx of patients. After multivariate adjustment for donor and recipient factors, graft (p = 0.68) and patient survival (p = 0.52) were similar between migrated and non-migrated patients.
A significant number of patients migrated in patterns that could not be explained alone by regional variations in MELD score and wait time. Migration may be a complex interplay of factors including referral patterns, specialized services at centers of excellence and patient preference.
在美国，前往寻求诸如肝移植（LT）等专科护理是一种现实情况。患者迁移被认为与器官可获得性有关。本研究的目的是描绘患者迁移模式以及肝移植后的结果。
从器官共享联合网络（UNOS）数据中提取2008年至2013年期间所有已故供体肝移植病例。迁移患者定义为那些在与他们居住地区不同的UNOS区域的中心接受肝移植且行程超过100英里的患者。
迁移患者占所进行的28700例肝移植的8.2%。在所有11个UNOS区域均观察到患者的流出和流入。第1、5、6和9区域有净流出，而第2、3、4、7、10和11区域有患者净流入。在对供体和受体因素进行多变量调整后，迁移患者和未迁移患者的移植物（p = 0.68）和患者生存率（p = 0.52）相似。
大量患者的迁移模式不能仅由终末期肝病模型（MELD）评分和等待时间的区域差异来解释。迁移可能是多种因素的复杂相互作用，包括转诊模式、卓越中心的专科服务和患者偏好。
