Goyes Daniela, Danford Christopher J, Nsubuga John Paul, Bonder Alan
Division of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Boston, MA, USA.
Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
Ann Hepatol. 2021 Jul-Aug;23:100304. doi: 10.1016/j.aohep.2021.100304. Epub 2021 Jan 12.
After the implementation of "Share 35", several concerns arose such as the potential to increase travel distance, costs, and decreased liver availability. These elements could have a negative impact on waitlist outcomes among ethnic minorities. We aimed to determine waitlist survival after the implementation of the Share 35 policy in non-Hispanic white and Hispanic patients.
We identified non-Hispanic whites and Hispanics who were listed for liver transplantation from June 18th, 2013 to June 18, 2018. We excluded pediatric patients, patients with acute hepatic necrosis, re-transplants, multiorgan transplant, living donor, and exception cases. The primary outcome was death or removal from the waitlist due to clinical deterioration. We used competing risk analysis to compare waitlist survival between the two groups.
There were 23,340 non-Hispanic whites and 4938 Hispanics listed for transplant. On competing risk analysis, Hispanic patients had a higher risk of being removed from the waitlist for death or clinical deterioration compared to their counterpart (SHR 1.23, 95% CI 1.13-1.34; P < 0.001).
After the implementation of Share 35, disparities are still present and continue to negatively impact outcomes in minority populations especially Hispanic patients.
“共享35”政策实施后，出现了一些问题，如出行距离可能增加、成本上升以及肝脏供体可用性降低。这些因素可能会对少数族裔在等待名单上的结果产生负面影响。我们旨在确定在非西班牙裔白人和西班牙裔患者中实施“共享35”政策后的等待名单生存率。
我们确定了2013年6月18日至2018年6月18日期间被列入肝移植等待名单的非西班牙裔白人和西班牙裔患者。我们排除了儿科患者、急性肝坏死患者、再次移植患者、多器官移植患者、活体供体和特殊病例。主要结局是因临床病情恶化导致死亡或从等待名单中移除。我们使用竞争风险分析来比较两组之间的等待名单生存率。
有23340名非西班牙裔白人和4938名西班牙裔患者被列入移植等待名单。在竞争风险分析中，与非西班牙裔白人患者相比，西班牙裔患者因死亡或临床病情恶化而从等待名单中被移除的风险更高（风险比1.23，95%置信区间1.13 - 1.34；P < 0.001）。
“共享35”政策实施后，差异仍然存在，并且继续对少数族裔人群尤其是西班牙裔患者的结局产生负面影响。
