Residence location and likelihood of kidney transplantation
Residence location and likelihood of kidney transplantation
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DOI：
10.1503/cmaj.051356
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发表时间：
2006-08-29
影响因子：
14.6
通讯作者：
Gill, John S.
中科院分区：
文献类型：
--
作者：
Tonelli, Marcello;Klarenbach, Scott;Gill, John S.
背景：在一个普遍的公共卫生保健系统中，获得肾移植不应受到居住地的影响。我们确定了居住在7个地理区域的加拿大透析患者中已故供者肾移植的可能性。在每个地区，我们还确定了离最近的移植中心的距离是否与移植的可能性有关。方法：对1996年至2000年间在加拿大开始透析的7034名受试者进行随机抽样研究。我们使用Cox比例风险模型在中位2.4年的时间内检验居住地与已故供者肾移植可能性之间的关系。结果：在不同地区之间，死亡供者肾移植的可能性和预测等待时间存在显著差异。例如，与安大略省的移植可能性相比，艾伯塔省调整后的移植相对可能性为3.74(95%可信区间[CI] 2.95-4.76) （p < 0.001）。在进一步调整死者器官捐献率的差异后，这些差异仍然存在。在区域内，居住在距离最近的移植中心50.1-150公里、150.1-300公里和300公里以上的患者接受肾脏移植的调整可能性与居住在50公里以内的患者相似。解释：在加拿大不同的地理区域，接受已故供者肾移植的调整后可能性有很大差异。相比之下，区域内移植的可能性不受距离最近的移植中心的距离的影响。
Background: In a universal, public health care system, access to kidney transplantation should not be influenced by residence location. We determined the likelihood of kidney transplantation from deceased donors among Canadian dialysis patients living in 7 geographic regions. Within each region we also determined whether distance from the closest transplant centre was associated with the likelihood of transplantation.Methods: A random sample of 7034 subjects initiating dialysis in Canada between 1996 and 2000 was studied. We used Cox proportional hazards models to examine the relation between residence location and the likelihood of kidney transplantation from deceased donors over a median period of 2.4 years.Results: There were significant differences in the likelihood of kidney transplantation from deceased donors and predicted waiting times between the different geographic regions. For example, the adjusted relative likelihood of transplantation in Alberta was 3.74 (95% confidence interval [CI] 2.95-4.76) compared with the likelihood in Ontario (p < 0.001). These differences persisted after further adjustment for differences in the rate of deceased organ donation. Within regions, patients who resided 50.1-150 km, 150.1-300 km and more than 300 km from the closest transplant centre had a similar adjusted likelihood of receiving a kidney transplant as those who lived less than 50 km away.Interpretation: The adjusted likelihood of undergoing a kidney transplant from a deceased donor varied substantially between geographic regions in Canada. In contrast, the likelihood of transplantation within regions was not affected by distance from the closest transplant centre.