Price Meghan J, Oshima Sachiko M, Guidot Daniel M, McElroy Lisa M, Snyder Laurie D, Joshi Sangeeta P
Johns Hopkins University School of Medicine, Division of Internal Medicine, Baltimore, Maryland.
Duke University School of Medicine, Department of Medicine, Durham, North Carolina.
JHLT Open. 2023 Oct 27;2:100012. doi: 10.1016/j.jhlto.2023.100012. eCollection 2023 Dec.
Innovations in organ preservation, surgical technique, and postoperative care have transformed solid organ transplantation. As organ transplantation becomes more common, potential racial, ethnic, and socioeconomic inequities in the referral and selection process are also emerging. Research studies highlight that patients from minoritized and low socioeconomic groups experience lower rates of referrals, reduced access to the transplant waitlist, higher rates of postoperative complications, and higher mortality rates for cardiothoracic (lung/heart) and abdominal (liver/kidney/pancreas) transplants. Yet, the drivers of these inequities are understudied and thus poorly understood. Strategies that address the root causes and mitigate these inequities are urgently needed. The purpose of this manuscript is not to be a systematic review, partially because there is limited research in this area, but to lay a roadmap toward equity in lung transplant. We highlight the available literature on lung transplantation inequities, identify critical needs, and propose strategies for the next steps. Our goal is to urge a call to action for the research community to systematically address the research in lung transplant disparities, and for health systems, organizations, and policymakers to implement the organizational and health system changes to meaningfully reduce these disparities.
器官保存、手术技术和术后护理方面的创新改变了实体器官移植。随着器官移植变得越来越普遍，转诊和选择过程中潜在的种族、族裔和社会经济不平等现象也日益凸显。研究表明，来自少数族裔和社会经济地位较低群体的患者转诊率较低，进入移植等待名单的机会减少，术后并发症发生率较高，心胸（肺/心脏）和腹部（肝脏/肾脏/胰腺）移植的死亡率也较高。然而，这些不平等现象的驱动因素研究不足，因此了解甚少。迫切需要采取解决根本原因并减轻这些不平等现象的策略。本手稿的目的不是进行系统综述，部分原因是该领域的研究有限，而是为实现肺移植公平性制定路线图。我们重点介绍了关于肺移植不平等现象的现有文献，确定了关键需求，并提出了下一步的策略。我们的目标是呼吁研究界采取行动，系统地解决肺移植差异方面的研究问题，并呼吁卫生系统、组织和政策制定者实施组织和卫生系统变革，以切实减少这些差异。
