Respiratory Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
GIS Health & Hazards Lab, Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, Cleveland, OH 44106, USA.
Int J Environ Res Public Health. 2022 Jun 15;19(12):7355. doi: 10.3390/ijerph19127355.
Lung transplantation is an increasingly common lifesaving therapy for patients with fatal lung diseases, but this intervention has a critical limitation as median survival after LT is merely 5.5 years. Despite the profound impact of place-based factors on lung health, this has not been rigorously investigated in LT recipients-a vulnerable population due to the lifelong need for daily life-sustaining immunosuppression medications. There have also been longstanding methodological gaps in transplant medicine where both time and place have not been measured; gaps which could be filled by the geospatial sciences. As part of an exploratory analysis, we studied recipients transplanted at our center over a two-year period. The main outcome was at least one episode of rejection within the first year after transplant. We found recipients averaged 1.7 unique residential addresses, a modest relocation rate. Lung rejection was associated with census tracts of predominantly underrepresented minorities or where English was not the primary language as measured by the social vulnerability index. Census tracts likely play an important role in measuring and addressing geographic disparities in transplantation. In a future paradigm, patient spatial data could become an integrated part of real time clinical care to aid in personalized risk stratification and personalized delivery of healthcare.
肺移植是一种越来越常见的挽救致命性肺部疾病患者生命的治疗方法，但这种干预手段存在一个关键的局限性，即 LT 后的中位生存时间仅为 5.5 年。尽管基于地点的因素对肺部健康有深远的影响，但这在 LT 受者中并没有得到严格的研究——由于需要终身使用维持生命的免疫抑制药物，LT 受者是一个脆弱的群体。在移植医学中也存在长期存在的方法学差距，其中时间和地点都没有得到测量；这些差距可以通过地理空间科学来填补。作为一项探索性分析的一部分，我们研究了在我们中心接受移植的患者在两年期间的情况。主要结果是移植后一年内至少发生一次排斥反应。我们发现，患者平均有 1.7 个独特的居住地址，这是一个适度的搬迁率。肺排斥反应与以社会脆弱性指数衡量的以代表性不足的少数族裔为主或英语不是主要语言的普查区有关。普查区可能在衡量和解决移植中的地理差异方面发挥重要作用。在未来的模式中，患者的空间数据可能成为实时临床护理的一个组成部分，以帮助进行个性化风险分层和个性化医疗保健。
