亚洲人群中肝移植的可及性与患者生存率：共享前35例共享后35例

Access to Liver Transplantation and Patient Survival among Asian Populations: Pre-Share 35 Post-Share 35.

作者信息

Zhang Y

机构信息

Department of Biostatistics, School of Public Health, University of Texas Health Science Center, Houston, TX, USA.

出版信息

Int J Organ Transplant Med. 2017;8(4):173-179. Epub 2017 Nov 1.

PMID:29321832

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5756898/

Abstract

BACKGROUND

Studies addressing ethnic disparities and trends in liver transplantation for Asian population are scant. Objective: To examine the impact of Share 35 policy on Asian patients' access to liver transplantation and outcomes since its implementation in June 2013.

METHODS

A total of 11,910 adult white and Asian patients who were registered for deceased donor liver transplantation between 2012 and 2015, was identified from the United Network for Organ Sharing database. Logistic regression and proportional hazard models with adjustment for demographic, clinical and geographic factors were used to model the access to liver transplantation and patient survival. Stratification on pre- and post-Share 35 periods was performed to compare the first 18 months of Share 35 policy to an equivalent period.

RESULTS

Comparison of the pre- and post-Share 35 periods showed a significant decrease in time on waiting list and higher proportions of patients receiving liver transplantation for Asian patients. Asians shared similar transplant rates as whites (OR: 1.15, 95% CI: 0.80-1.67) but experienced significantly longer waiting time (HR: 0.56, 95% CI: 0.34-0.92) before they received liver transplantation after Share 35 policy took effect. No significant post-transplantation survival difference was observed between Asians and whites at the 18-month outcome.

CONCLUSION

Although benefited from the Share 35 policy, Asian patients are still at greater risk of disparities in access to liver transplantation.

摘要

背景

针对亚洲人群肝移植种族差异及趋势的研究较少。目的：探讨2013年6月实施的“共享35”政策对亚洲患者肝移植可及性及预后的影响。

方法

从器官共享联合网络数据库中识别出2012年至2015年间登记接受已故供体肝移植的11910名成年白人和亚洲患者。采用逻辑回归和比例风险模型，并对人口统计学、临床和地理因素进行调整，以模拟肝移植可及性和患者生存率。对“共享35”政策实施前后进行分层，将“共享35”政策实施的前18个月与同期进行比较。

结果

“共享35”政策实施前后的比较显示，亚洲患者的等待名单时间显著缩短，接受肝移植的患者比例更高。亚洲人的移植率与白人相似（比值比：1.15，95%置信区间：0.80-1.67），但在“共享35”政策生效后接受肝移植之前，等待时间显著更长（风险比：0.56，95%置信区间：0.34-0.92）。在18个月的随访结果中，未观察到亚洲人和白人在移植后生存率上的显著差异。