Huang Dora C, Fricker Zachary P, Alqahtani Saleh, Tamim Hani, Saberi Behnam, Bonder Alan
Department of Internal Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215, United States.
Division of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States.
EClinicalMedicine. 2021 Sep 16;41:101137. doi: 10.1016/j.eclinm.2021.101137. eCollection 2021 Nov.
Survival following liver transplant (LT) is influenced by a variety of factors, including donor risk factors and recipient disease burden and co-morbidities. It is difficult to separate these effects from those of socioeconomic factors, such as income or insurance. The United Network for Organ Sharing (UNOS) created equitable access policies, such as Share 35, to ensure that organs are distributed to individuals with greatest medical need; however, the effect of Share 35 on disparities in post-LT survival is not clear. This study aimed to (1) characterize associations between post-transplant survival and race and ethnicity, income, insurance, and citizenship status, when adjusted for other clinical and demographic factors that may influence survival, and (2) determine if the direction of associations changed after Share 35.
A retrospective, cohort study of adult LT recipients ( = 83,254) from the UNOS database from 2005 to 2019 was conducted. Kaplan-Meier survival graphs and stepwise multivariate cox-regression analyses were performed to characterize the effects of socioeconomic status on post-LT survival, adjusted for recipient and donor characteristics, across the time period and after Share 35.
Male sex (HR: 0.93 (95% CI: 0.90-0.96)), private insurance (0.91 (0.88-0.94)), income (0.82 (0.79-0.85)), U.S. citizenship, and Asian (0.81 (0.75-0.88)) or Hispanic (0.82 (0.79-0.86)) race and ethnicity were associated with higher post-transplant survival, after adjustment for clinical and demographic factors (Table 3). These associations were found across the entire time period studied and many persisted after the implementation of Share 35 in 2013 (Table 3; male sex (0.84 (0.79-0.90)), private insurance (0.94 (0.89-1.00)), income (0.82 (0.77-0.89)), and Asian (0.87 (0.73-1.02)) or Hispanic (0.88 (0.81-0.96)) race and ethnicity).
Recipients' socioeconomic factors at time of transplant may impact long-term post-transplant survival, and a single policy may not significantly alter these structural health inequalities.
None.
肝移植（LT）后的生存率受多种因素影响，包括供体风险因素、受体疾病负担和合并症。很难将这些影响与社会经济因素（如收入或保险）的影响区分开来。器官共享联合网络（UNOS）制定了公平分配政策，如“共享35”政策，以确保器官分配给医疗需求最大的个体；然而，“共享35”政策对肝移植后生存差异的影响尚不清楚。本研究旨在：（1）在调整可能影响生存的其他临床和人口统计学因素后，描述移植后生存与种族、民族、收入、保险和公民身份之间的关联；（2）确定在“共享35”政策实施后这些关联的方向是否发生变化。
对2005年至2019年UNOS数据库中的成年肝移植受者（n = 83254）进行了一项回顾性队列研究。采用Kaplan-Meier生存曲线和逐步多变量Cox回归分析，以描述社会经济状况对肝移植后生存的影响，并在整个时间段以及“共享35”政策实施后，对受体和供体特征进行了调整。
在调整临床和人口统计学因素后，男性（HR：0.93（95%CI：0.90 - 0.96））、私人保险（0.91（0.88 - 0.94））、收入（0.82（0.79 - 0.85））、美国公民身份以及亚洲（0.81（0.75 - 0.88））或西班牙裔（0.82（0.79 - 0.86））种族与民族与移植后较高的生存率相关（表3）。在整个研究时间段内均发现了这些关联，并且在2013年实施“共享35”政策后许多关联仍然存在（表3；男性（0.84（0.79 - 0.90））、私人保险（0.94（0.89 - 1.00））、收入（0.82（0.77 - 0.89））以及亚洲（0.87（0.73 - 1.02））或西班牙裔（0.88（0.81 - 0.96））种族与民族）。
移植时受体的社会经济因素可能会影响移植后的长期生存，单一政策可能无法显著改变这些结构性健康不平等状况。
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