美国肝脏分配与分布中的地理差异：我们目前的状况如何？

Geographic Disparities in Liver Allocation and Distribution in the United States: Where Are We Now?

作者信息

Spaggiari Mario, Okoye Obi, Tulla Kiara, Di Cocco Pierpaolo, Almario Jorge, Benedetti E, Tzvetanov Ivo

机构信息

Division of Transplantation, Department of General Surgery, University of Illinois at Chicago, Chicago, Illinois.

出版信息

Transplant Proc. 2019 Dec;51(10):3205-3212. doi: 10.1016/j.transproceed.2019.07.018. Epub 2019 Nov 13.

DOI:10.1016/j.transproceed.2019.07.018

PMID:31732201

Abstract

BACKGROUND

Equitable deceased donor liver allocation and distribution has remained a heated topic in transplant medicine. Despite the establishment of numerous policies, mixed reports regarding organ allocation persist.

METHODS

Patient data was obtained from the United Network for Organ Sharing liver transplant database between January 2016 and September 2017. A total of 20,190 patients were included in the analysis. Of this number, 8790 transplanted patients had a median Model for End-Stage Liver Disease (MELD) score of 25 (17-33), after a wait time of 129 (32-273) days. Patients were grouped into low MELD and high MELD regions using a score 25 as the cutoff.

RESULTS

Significant differences were noted between low and high MELD regions in ethnicity (white 77.4% vs 60.4%, Hispanic 8.1% vs 24.5%; P < .001) and highest level of education (grade school 4.8% vs 8.5%, Associate/Bachelor's degree 19% vs 15.7%, P < .001), respectively. Patients in high MELD regions were more likely to be multiply listed if they had a diagnosis of hepatocellular carcinoma (12.1% vs 15%, P = .046). Wait-list mortality (4.8% vs 6%, P < .001) and wait-list time (110 [27-238] vs 156 [42-309] days, P < .001) were greater in the high MELD regions.

CONCLUSIONS

These results highlight some of the existing disparities in the recently updated allocation and distribution policy of deceased donor livers. Our findings are consistent with previous work and support the liver distribution policy revision.

摘要

背景

公平的已故供体肝脏分配一直是移植医学中的热门话题。尽管制定了众多政策，但关于器官分配的报告仍参差不齐。

方法

从器官共享联合网络肝脏移植数据库中获取2016年1月至2017年9月期间的患者数据。共有20190名患者纳入分析。其中，8790名移植患者的终末期肝病模型（MELD）评分中位数为25（17 - 33），等待时间为129（32 - 273）天。以25分为界值，将患者分为低MELD和高MELD区域。

结果

低MELD和高MELD区域在种族（白人77.4%对60.4%，西班牙裔8.1%对24.5%；P <.001）和最高教育水平（小学4.8%对8.5%，大专/本科学位19%对15.7%，P <.001）方面存在显著差异。高MELD区域中诊断为肝细胞癌的患者更有可能被多次列入名单（12.1%对15%，P = 0.046）。高MELD区域的等待名单死亡率（4.8%对6%，P <.001）和等待名单时间（110 [27 - 238]天对156 [42 - 309]天，P <.001）更高。