Goyes Daniela, Nsubuga John Paul, Medina-Morales Esli, Barba Romelia, Patwardhan Vilas, Saberi Behnam, Fricker Zachary, Bonder Alan
Department of Medicine, Loyola Medicine-MacNeal Hospital, Berwyn, IL 60402, USA.
Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA.
J Clin Med. 2021 Dec 13;10(24):5826. doi: 10.3390/jcm10245826.
(1) Background: Since 2015, exception points have been awarded to appropriate candidates after six months of waitlist time to allow more equitable access to liver transplants regardless of hepatocellular carcinoma status. However, it remains unknown whether racial disparities in outcomes among waitlisted patients remain after the introduction of a 6-month waiting period for exception points. (2) Methods: Using the United Network for Organ Sharing database, we identified 2311 patients diagnosed with hepatocellular carcinoma listed for liver transplant who received exception points from 2015 to 2019. The outcome of interest was waitlist survival defined as the composite outcome of death or removal for clinical deterioration. Competing risk analysis was used to identify factors associated with death or removal for clinical deterioration. The final model adjusted for age, sex, race/ethnicity, blood type, diabetes, obesity, laboratory MELD score, tumor size, AFP, locoregional therapies, UNOS region, and college education. (3) Results: No difference was found in the risk of adverse waitlist removal among ethnic/racial groups.
（1）背景：自2015年以来，在等待名单上等待六个月后，符合条件的候选人可获得额外加分，以便无论肝细胞癌状态如何，都能更公平地获得肝移植。然而，在引入为期6个月的额外加分等待期后，等待名单上患者的结局种族差异是否仍然存在尚不清楚。（2）方法：利用器官共享联合网络数据库，我们识别出2311名2015年至2019年期间被诊断为肝细胞癌并列入肝移植等待名单且获得额外加分的患者。感兴趣的结局是等待名单生存，定义为因临床恶化导致的死亡或移除的复合结局。采用竞争风险分析来识别与因临床恶化导致的死亡或移除相关的因素。最终模型对年龄、性别、种族/民族、血型、糖尿病、肥胖、实验室终末期肝病模型（MELD）评分、肿瘤大小、甲胎蛋白、局部区域治疗、器官共享联合网络（UNOS）区域和大学教育程度进行了校正。（3）结果：在不同种族/民族群体中，等待名单上不良移除风险未发现差异。
