美国肝移植的趋势与差异：对人口统计学、临床及社会经济因素的全国性分析（2016 - 2021年）

Trends and Disparities in Liver Transplantation in the United States: A Nationwide Analysis of Demographic, Clinical, and Socioeconomic Factors (2016-2021).

作者信息

Nagesh Vignesh Krishnan, Varughese Vivek Joseph, Basta Marina, Martinez Emelyn, Badam Shruthi, Shobana Lokaesh Subramani, Mohamed Abdifitah, J Alin, Weissman Simcha, Atoot Adam

机构信息

Department of Internal Medicine, Hackensack Palisades Medical Center, North Bergen, NJ 07047, USA.

Department of Internal Medicine, University of South Carolina, Columbia, SC 29208, USA.

出版信息

Med Sci (Basel). 2025 Jun 1;13(2):66. doi: 10.3390/medsci13020066.

DOI:10.3390/medsci13020066

PMID:40559224

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12195059/

Abstract

BACKGROUND

Liver transplantation has become the standard of care for patients with end-stage liver disease. Despite advances in surgical techniques, immunosuppression, and perioperative care, disparities in access and outcomes persist across demographic and socioeconomic lines.

OBJECTIVE

To assess trends and disparities in liver transplant admissions in the United States from 2016 to 2021, examining demographic patterns, in-hospital mortality, hospital charges, length of stay, and socioeconomic factors.

METHODS

Using the National Inpatient Sample (NIS) from 2016 to 2021, we identified liver transplant admissions using ICD-10 PCS codes 0FY00Z1 and 0FY00Z2. Demographic characteristics (age, sex, race, insurance status, and income quartile), clinical outcomes, and resource utilization metrics were analyzed. One-way ANOVA and Hensel's test were used to assess variance and distribution homogeneity, with a significance threshold of < 0.05.

RESULTS

A total of 9677 liver transplant admissions were analyzed. The mean recipient age remained stable (51-52 years), with males comprising ~~62% of transplants. White patients constituted the largest group of recipients (~~66-68%), followed by Hispanic (~~14-17%) and Black patients (~~7-10%). The proportion of transplants relative to liver failure admissions remained stable across racial groups, indicating no widening racial gap during the study period. In-hospital mortality post-transplant remained low (2.37-3.52%) and did not differ significantly by race ( = 0.23), sex ( = 0.24), or income quartile ( = 0.13). Similarly, Charlson Comorbidity Index > 5 did not predict inpatient mortality ( = 0.154). Hospital charges ranged from $578,000 to $766,000, with an average stay of ~21 days.

CONCLUSIONS

Liver transplantation outcomes, including in-hospital mortality, appear consistent across demographic and socioeconomic groups once patients are admitted for transplant. However, broader disparities in access persist, necessitating further research into pre-transplant barriers and long-term outcomes. These findings support the need for equitable healthcare strategies aimed at optimizing transplant candidacy and survival across all populations.

摘要

背景

肝移植已成为终末期肝病患者的标准治疗方法。尽管手术技术、免疫抑制和围手术期护理取得了进展，但在不同人口统计学和社会经济背景下，肝移植的可及性和治疗结果仍存在差异。

目的

评估2016年至2021年美国肝移植入院情况的趋势和差异，研究人口统计学模式、住院死亡率、住院费用、住院时间和社会经济因素。

方法

利用2016年至2021年的全国住院患者样本（NIS），我们使用国际疾病分类第十版临床修订本（ICD-10-PCS）编码0FY00Z1和0FY00Z2识别肝移植入院病例。分析了人口统计学特征（年龄、性别、种族、保险状况和收入四分位数）、临床结果和资源利用指标。采用单因素方差分析和亨泽尔检验评估方差和分布同质性，显著性阈值<0.05。

结果

共分析了9677例肝移植入院病例。受者的平均年龄保持稳定（51 - 52岁），男性约占移植病例的62%。白人患者是最大的受者群体（约66% - 68%），其次是西班牙裔（约14% - 17%）和黑人患者（约7% - 10%）。各种族群体中，肝移植相对于肝衰竭入院病例的比例保持稳定，表明在研究期间种族差距没有扩大。移植后的住院死亡率仍然较低（2.37% - 3.52%），在种族（P = 0.23）、性别（P = 0.24）或收入四分位数（P = 0.13）方面没有显著差异。同样，查尔森合并症指数>5并不能预测住院死亡率（P = 0.154）。住院费用从57.8万美元到76.6万美元不等，平均住院时间约为21天。