在胰腺分配制度前后时代，同时进行胰腺和肾移植的机会存在地域差异。

Geographic Disparities in Access to Simultaneous Pancreas and Kidney Transplant in the Pre- and Post-Pancreas Allocation System Eras.

机构信息

Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN.

Department of Surgery, Department of Biostatistics, Vanderbilt Transplant Center, Vanderbilt University Medical Center, Nashville, TN.

出版信息

Transplantation. 2020 Mar;104(3):623-631. doi: 10.1097/TP.0000000000002850.

DOI:10.1097/TP.0000000000002850

PMID:31335772

Abstract

BACKGROUND

The 2014 pancreas allocation system (PAS) intended to decrease geographic variability in listing practices for simultaneous pancreas and kidney (SPK) transplant and define eligibility criteria for those with type 2 diabetes mellitus (T2DM). Our primary aims were to evaluate geographic disparities in access to SPK and assess T2DM SPK listings in the pre- and post-PAS eras.

METHODS

Adult listings for SPK and kidney transplant (pre-PAS, January 2010 to October 29, 2014; post-PAS, October 30, 2014, to June 2, 2017) were identified in the Scientific Registry of Transplant Recipients. Multivariable logistic regression models tested associations of geography and/or diabetes mellitus type on the likelihood of SPK versus kidney transplant listing pre- and post-PAS. Competing risk models tested the likelihood of SPK transplantation within 2 years of listing for SPK.

RESULTS

Among 41 205 listings (27 393 pre-PAS; 24 439 T2DM), univariate analysis showed reduced percentages for SPK post-PAS (22.1%-20.8%; P = 0.003). After adjusting for patient and center characteristics, geographic disparities declined slightly but persisted post-PAS (era by region interaction P < 0.001). The era by type of diabetes mellitus interaction effect was statistically significant (P = 0.039), reflecting that the proportions of SPK listings for T2DM increased in the post-PAS era (3.4%-3.9%; univariate P = 0.038), while those for type 1 diabetes mellitus remained statistically stable (47.9%-48.4%; univariate P = 0.571). Among people listed for SPK, geographic disparities in the cumulative incidence of transplantation within 2 years declined and the overall likelihood of transplantation increased in the post-PAS era (both P < 0.001).

CONCLUSIONS

Geographic disparities in access to SPK declined slightly but persisted post-PAS. With new allocation change proposals and elimination of listing criteria for T2DM, further monitoring is warranted.

摘要

背景

2014 年胰腺分配系统（PAS）旨在减少同时胰腺和肾脏（SPK）移植的上市实践中的地域差异，并为 2 型糖尿病（T2DM）患者定义资格标准。我们的主要目的是评估 SPK 获得的地域差异，并评估 PAS 前后 T2DM SPK 上市情况。

方法

在移植受者科学注册处确定了 SPK 和肾移植的成人上市情况（PAS 前，2010 年 1 月至 2014 年 10 月 29 日；PAS 后，2014 年 10 月 30 日至 2017 年 6 月 2 日）。多变量逻辑回归模型测试了地理和/或糖尿病类型对 PAS 前后 SPK 与肾移植上市可能性的关联。竞争风险模型测试了 SPK 上市后 2 年内进行 SPK 移植的可能性。

结果

在 41205 个上市案例中（PAS 前 27393 例，2 型糖尿病 24439 例），单变量分析显示 PAS 后 SPK 的百分比降低（22.1%-20.8%；P=0.003）。在调整了患者和中心特征后，地域差异略有下降，但 PAS 后仍持续存在（时代与地区交互 P<0.001）。糖尿病类型的时代与交互效应具有统计学意义（P=0.039），反映了 PAS 后 T2DM 的 SPK 上市比例增加（3.4%-3.9%；单变量 P=0.038），而 1 型糖尿病的比例保持统计学稳定（47.9%-48.4%；单变量 P=0.571）。在 SPK 上市的人群中，2 年内移植累积发生率的地域差异下降，PAS 后总体移植可能性增加（均 P<0.001）。