Division of Hepatobiliary and Abdominal Organ Transplant Surgery, University of Southern California, Los Angeles, California, USA.
Lawrence J. Ellison Institute for Transformative Medicine, University of Southern California, Los Angeles, California, USA.
Clin Transplant. 2021 Oct;35(10):e14418. doi: 10.1111/ctr.14418. Epub 2021 Jul 19.
The Affordable Care Act (ACA) and subsequent Medicaid expansion has increased utilization of public health insurance. Living donor liver transplantation (LDLT) increases access to transplant and is associated with improved survival but consistently represents < 5% of LT in the United States.
National registry data were analyzed to evaluate the impact of insurance payor on waitlist mortality and LDLT rates at LDLT centers since implementation of the ACA.
Public insurance [Medicare RR 1.18 (1.13-1.22) P < .001, Medicaid RR 1.22 (1.18-1.27) P < .001], Latino ethnicity (P < .001), and lower education level (P = .02) were associated with increased waitlist mortality at LDLT centers. LDLT recipients were more likely to have private insurance (70.4% vs. 59.4% DDLT, P < .001), be Caucasian (92.1% vs. 83% DDLT, P < .001), and have post-secondary education (66.8% vs. 54.1% DDLT, P < .001). Despite 78% of LDLT centers being located in states with Medicaid expansion, there was no change in LDLT utilization among recipients with Medicaid (P = .196) or Medicare (P = .273).
Despite Medicaid expansion, registry data suggests that patients with public medical insurance may experience higher waitlist mortality and underutilize LDLT at centers offering LDLT. It is possible that Medicaid expansion has not increased access to LDLT.
平价医疗法案（ACA）和随后的医疗补助扩展增加了公共健康保险的利用率。活体供肝移植（LDLT）增加了接受移植的机会，与改善生存相关，但始终代表美国 LT 的<5%。
国家登记数据进行分析，以评估自 ACA 实施以来，保险支付者对 LDLT 中心等待名单死亡率和 LDLT 率的影响。
公共保险[医疗保险 RR 1.18（1.13-1.22）P<.001，医疗补助 RR 1.22（1.18-1.27）P<.001]、拉丁裔种族（P<.001）和较低的教育水平（P=.02）与 LDLT 中心等待名单死亡率增加相关。LDLT 受者更有可能拥有私人保险（70.4% vs. 59.4% DDLT，P<.001）、白种人（92.1% vs. 83% DDLT，P<.001）和接受过高等教育（66.8% vs. 54.1% DDLT，P<.001）。尽管 78%的 LDLT 中心位于实施医疗补助扩展的州，但 Medicaid 受者或 Medicare 受者的 LDLT 利用率没有变化（P=.196）或 Medicare（P=.273）。
尽管 Medicaid 扩大了，但登记数据表明，拥有公共医疗保险的患者可能在提供 LDLT 的中心等待名单死亡率更高，并且 LDLT 的利用率较低。 Medicaid 扩展可能并未增加 LDLT 的机会。
