Following the Organ Supply: Assessing the Benefit of Inter-DSA Travel in Liver Transplantation
Following the Organ Supply: Assessing the Benefit of Inter-DSA Travel in Liver Transplantation
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DOI：
10.1097/tp.0b013e3182737cfb
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发表时间：
2013-01-27
期刊：
影响因子：
6.2
通讯作者：
Axelrod, David A.
中科院分区：
文献类型：
--
作者：
Dzebisashvili, Nino;Massie, Allan B.;Axelrod, David A.
背景。尽管联邦政府指示减少地域差异，但在美国，获得肝移植（LT）的机会仍然存在差异。我们评估了社会经济地位（SES）和前往替代捐赠服务区（dsa）对患者生存的影响。一项整合移植登记和美国人口普查数据的前瞻性队列研究使用多变量线性Cox比例风险模型进行分析。一项单独的配对分析用于评估旅行对患者生存和移植率的益处。高SES与获得LT的机会增加（调整后的风险比[aHR]， 1.05； 95%可信区间[95% CI]， 1.01-1.08）和等候名单后死亡率降低（aHR [95% CI], 0.88[0.85-0.93]）相关。在一定程度上，通过dsa之间的旅行来调节访问的增加。旅行与高SES、白种人、O型血、私人保险和居住在1、5和11地区有关。社会经济地位最高的四分位数的移植候选者比社会经济地位最低的四分位数的候选者旅行的可能性大约高70% （aHR [95% CI], 1.67[1.43-1.97]）。与匹配的对照患者相比，旅行者移植的可能性高74% (aHR [95% CI], 1.74[1.56-1.94])，上市后死亡的可能性低20% （aHR [95% CI], 0.79[0.69-0.92]）。高SES和dsa间旅行与LT通路增加和死亡率降低密切相关。旅行者更有可能是社会人口优势和私人保险，并生活在难以获得死者捐献器官的地区。
Background. Disparity in access to liver transplantation (LT) in the United States persists despite directives from the federal government to reduce geographic variation. We assessed the impact of socioeconomic status (SES) and traveling to alternative donation service areas (DSAs) on patient survival.Methods. A prospective cohort study integrating transplant registry and U. S. Census data was analyzed using multivariate linear Cox proportional hazards models. A separate matched-pairs analysis was used to assess the benefit of traveling on patient survival and transplantation rate.Results. High SES is associated with increased access to LT (adjusted hazard ratio [aHR], 1.05; 95% confidence interval [95% CI], 1.01-1.08) and reduced mortality after waitlisting (aHR [95% CI], 0.88 [0.85-0.93]). Increased access is mediated, in part, through inter-DSA travel. Travel was associated with high SES, white race, blood group O, private insurance, and residence in regions 1, 5, and 11. Transplant candidates in the highest SES quartile were approximately 70% more likely to travel (aHR [95% CI], 1.67 [1.43-1.97]) than those in the lowest SES quartile. Compared with matched control patients, travelers were 74% more likely to be transplanted (aHR [95% CI], 1.74 [1.56-1.94]) and 20% less likely to die after listing (aHR [95% CI], 0.79 [0.69-0.92]).Conclusion. High SES and inter-DSA travel are strongly associated with increased LT access and reduced mortality. Travelers are more likely to be sociodemographically advantaged and privately insured and to live in regions with reduced access to deceased-donor organs.