Agence de la Biomédecine, Medical and Scientific Department, Simulation and Health Geography Units, Saint-Denis La Plaine cedex, France.
Agence de la Biomédecine, Direction générale médicale et scientifique, Direction Prélèvement Greffe Organes - Tissus, Pôle Stratégie Prélèvement Greffe, Saint-Denis-la-Plaine cedex, France.
Am J Transplant. 2021 Mar;21(3):1080-1091. doi: 10.1111/ajt.16214. Epub 2020 Oct 1.
Geographic disparities emerged as an increasing issue in organ allocation policies. Because of the sequential and discrete geographical models used for allocation scores, artificial regional boundaries may impede the access of candidates with the greatest medical urgency to vital organs. This article describes a continuous geographical allocation model that provides accurate organ access by introducing a multiplicative interaction between the patient's condition and the distance to the graft by using a gravity model. Patients with the most urgent need will thus have access to organs from farther away, while those in less urgent need may only have access to organs geographically closer. Compared to the previous French liver allocation scheme, the gravity model precluded transplantations for candidates with a Model for End-Stage Liver Disease (MELD) ≤ 14 for decompensated cirrhosis from 10.3% to 0.6%. Death and delisting while on the waiting list at 1 year also decreased from 30.1% to 22.4% for MELD ≥ 35. Waiting list (cumulative hazard ratio (CHR) 0.84 after adjustment) and posttransplant survival improved significantly (hazard ratio = 0.83 after adjustment). This new liver allocation system provides more equitable access to liver transplants and an efficient and safe alternative to administrative boundaries for geographical models in organ allocation.
地理差异在器官分配政策中成为一个日益严重的问题。由于分配分数采用顺序和离散的地理模型，人为的区域边界可能会阻碍最需要的候选人获得重要器官。本文描述了一种连续的地理分配模型，通过使用重力模型在患者病情和与供体的距离之间引入乘法交互作用，为患者提供准确的器官获取途径。因此，最急需的患者将能够获得来自更远地方的器官，而那些需求不太紧急的患者可能只能获得地理上更近的器官。与之前的法国肝脏分配方案相比，重力模型使肝功能衰竭模型（MELD）≤14 的失代偿性肝硬化患者的移植率从 10.3%降至 0.6%。MELD≥35 的患者在等待名单上的死亡和除名率也从 30.1%下降到 22.4%。等待名单（调整后的累积风险比（CHR）为 0.84）和移植后存活率显著提高（调整后的风险比=0.83）。这种新的肝脏分配系统为肝脏移植提供了更公平的机会，并且为器官分配中的地理模型提供了一种高效、安全的替代行政边界的方法。
