Racial disparities in patient selection for liver transplantation: An ongoing challenge
Racial disparities in patient selection for liver transplantation: An ongoing challenge
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DOI：
10.1111/ctr.13714
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发表时间：
2019-10-22
影响因子：
2.1
通讯作者：
Yoshida, Atsushi
中科院分区：
文献类型：
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作者：
Jesse, Michelle T.;Abouljoud, Marwan;Yoshida, Atsushi
充足的证据表明，一旦被列为肝移植，种族差异仍然存在，尽管很少有研究调查在选择过程中的差异。本研究的目的是通过回顾性病历审查，确定肝移植列表是否受社会经济地位和人种/种族的影响。我们确定了1968例终末期肝病患者，这些患者于2004年1月1日至2012年12月31日在一家大型中西部中心接受了评价（72.9%白色，19.6%黑人，7.5%其他）。超过一半（54.6%）的评价患者被收载;未收载的三个最常见原因是医学禁忌症（11.9%）、患者在评价期间死亡（7.0%）和心理社会禁忌症（5.9%）。在多变量logistic回归分析中（已列出与未列出），在三个种族类别中，酒精性肝炎（+/-丙型肝炎）、未婚、一种以上保险、保险不足和家庭年收入四分位数较低的患者被列出的几率较低。类似的因素预测了移植上市的时间，包括被确定为黑人种族。与所有其他患者相比，即使调整了上述医疗和社会经济因素，黑人患者的入组几率也低26%，且入组决定时间较长。
Ample evidence suggests continued racial disparities once listed for liver transplantation, though few studies examine disparities in the selection process for listing. The objective of this study, via retrospective chart review, was to determine whether listing for liver transplantation was influenced by socioeconomic status and race/ethnicity. We identified 1968 patients with end-stage liver disease who underwent evaluation at a large, Midwestern center from January 1, 2004 through December 31, 2012 (72.9% white, 19.6% black, and 7.5% other). Over half (54.6%) of evaluated patients were listed; the three most common reasons for not listing were medical contraindications (11.9%), patient expired during evaluation (7.0%), and psychosocial contraindications (5.9%). In multivariable logistic regressions (listed vs not listed), across the three racial categories, the odds of being listed were lower for alcohol-induced hepatitis (+/- hepatitis C), unmarried, more than one insurance, inadequate insurance, and lower annual household income quartile. Similar factors predicted time to transplant listing, including being identified as black race. Black race, even when adjusting for the above mentioned medical and socioeconomic factors, was associated with 26% lower odds of being listed and a longer time to listing decision compared to all other patients.