Variation in Racial Disparities in Liver Transplant Outcomes Across Transplant Centers in the United States.
Variation in Racial Disparities in Liver Transplant Outcomes Across Transplant Centers in the United States.
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DOI：
10.1002/lt.25918
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发表时间：
2021-04
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影响因子：
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通讯作者：
Patzer R
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文献类型：
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作者：
Ross-Driscoll K;Kramer M;Lynch R;Plantinga L;Wedd J;Patzer R
关于移植中心在肝移植后长期存在种族差异的作用知之甚少，这是患者级因素出乎意料的。从2010年到2017年，我们使用移植受体（SRTR）的科学注册表。移植中心特异性的黑白危害比和分层生存分析，以检查种族 - 苏里维尔中心特征（包括移植体积，黑人患者比例，SRTR质量等级和模型）的潜在效应。临床，社会经济和中心特征。与白人患者相比，100人年（95％置信区间[CI]，0.65-1.56），对应于21％的死亡率风险（95％CI，1.12-1.31）。中心没有迹象表明，移植中心体积，少数族裔患者的比例，质量等级或地区。在移植中心之间的这种差异很大，这是通过选定的中心特征来解释的。作为选择过程和后续护理，需要建立有效的中心干预措施来解决健康不平等。
Little is known about the role that transplant centers may play in perpetuating racial disparities after liver transplantation, which are unexplained by patient-level factors. We examined variation in between-center and within-center disparities among 34,114 Black and White liver transplant recipients in the United States from 2010 to 2017 using Scientific Registry of Transplant Recipient (SRTR) data. We used Cox proportional hazards models to calculate transplant center-specific Black–White hazard ratios and hierarchical survival analysis to examine potential effect modification of the race–survival association by transplant center characteristics, including transplant volume, proportion of Black patients, SRTR quality rating, and region. Models were sequentially adjusted for clinical, socioeconomic, and center characteristics. After adjustment, Black patients experienced 1.11 excess deaths after liver transplant per 100 person-years compared with White patients (95% confidence interval [CI], 0.65-1.56), corresponding to a 21% increased mortality risk (95% CI, 1.12-1.31). Although there was substantial variation in this disparity across transplant centers, there was no evidence of effect modification by transplant center volume, proportion of minority patients seen, quality rating, or region. We found significant racial disparities in survival after transplant, with substantial variation in this disparity across transplant centers that was not explained by selected center characteristics. This is the first study to directly evaluate the role transplant centers play in racial disparities in transplant outcomes. Further assessment of the qualitative factors that may drive disparities, such as selection processes and follow-up care, is needed to create effective center-level interventions to address health inequity.