Adler Joel T, Bababekov Yanik J, Markmann James F, Chang David C, Yeh Heidi
Department of Surgery, Massachusetts General Hospital, Boston, MA, USA.
Pediatr Transplant. 2017 Mar;21(2). doi: 10.1111/petr.12842. Epub 2016 Nov 1.
The distance to liver transplant centers affects outcomes in adult liver transplantation. Because pediatric patients are particularly vulnerable, we hypothesized that distance adversely affects the time to transplantation and waitlist mortality. The SRTR was queried for isolated pediatric liver transplant registrants (under age 18) with valid ZIP code information from 2003 to 2012. Distance was measured from home ZIP code to listing transplant center. Competing events analysis, adjusted for demographic factors, indication, and PELD, was undertaken for transplantation and death while on the waitlist. The median distance to listing transplant center for 6924 children was 65 (IQR 17.5-189) miles. Median distance traveled increased by listing volume (73.9 vs 33.8 miles, highest vs lowest volume quartile, P<.001 for trend) and varied across the country. Longer distance was not associated with time to transplantation (HR 0.99, longest vs shortest distance quartile, P=.80), but was associated with increased mortality (HR 1.75, P<.001). Larger centers attract patients from a distance, while smaller centers serve local populations. Increasing distance is associated with a higher risk of waitlist death, which may reflect decreased access to specialist and tertiary care associated with a transplant center.
与肝移植中心的距离会影响成人肝移植的结果。由于儿科患者特别脆弱，我们推测距离会对移植时间和等待名单上的死亡率产生不利影响。我们查询了器官获取与移植网络（SRTR）中2003年至2012年有有效邮政编码信息的孤立儿科肝移植登记者（18岁以下）。距离是从家庭邮政编码到列出的移植中心进行测量的。对等待名单上的移植和死亡进行了竞争事件分析，并对人口统计学因素、适应症和小儿终末期肝病评分（PELD）进行了调整。6924名儿童到列出的移植中心的中位距离为65（四分位间距17.5 - 189）英里。出行的中位距离随着列出的移植量增加而增加（73.9英里对33.8英里，最高移植量四分位对最低移植量四分位，趋势P <.001），并且在全国范围内有所不同。距离较长与移植时间无关（风险比0.99，最长距离四分位对最短距离四分位，P = 0.80），但与死亡率增加有关（风险比1.75，P <.001）。较大的中心吸引来自远方的患者，而较小的中心服务当地人群。距离增加与等待名单死亡风险较高相关，这可能反映了与移植中心相关的专科和三级医疗服务可及性降低。
