Geographic disparities in lung transplantation in the United States before and after the November 2017 allocation change.
Geographic disparities in lung transplantation in the United States before and after the November 2017 allocation change.
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DOI：
10.1016/j.healun.2021.11.002
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发表时间：
2022-03
影响因子：
8.9
通讯作者：
Arcasoy, Selim M.
中科院分区：
文献类型：
--
作者：
Benvenuto, Luke J.;Anderson, Michaela R.;Aversa, Meghan;Snyder, Mark E.;Robbins, Hilary;Shah, Lori;Grewal, Harpreet Singh;Anderson, David;Costa, Joseph;Stanifer, Brian P.;Lemaitre, Philippe;Sonett, Joshua R.;D'Ovidio, Frank;Arcasoy, Selim M.
初级肺分配单元于2017年从捐赠服务区扩大到250英里半径。在这一变化之前，供体肺可用性的地理差异影响了等待名单的结果。我们试图确定新的分配制度是否改善了这些差距。我们进行了一项回顾性队列研究，比较了变更前后的2年时间。供体肺可用性定义为主要分配单元中供体肺与等待名单候选人的比率。移植中心按供体肺可用性分为四分位数。多变量竞争风险模型用于确定肺可用性和等待名单结果之间的关联。多变量考克斯比例风险模型比较移植后存活率。在分配变化之前，最低和最高四分位数中心的未经调整的移植率分别为每100等待名单年132例和607例移植。与最高四分位数的候选人相比，供体肺可用性最低四分位数的候选人的调整后移植率低61%（亚危险比[sHR]：0.39，95%置信区间[CI]：0.34-0.44）。分配变化后，差异减小，导致最低和最高四分位数中心的未调整移植率分别为141和309。最低四分位数的候选人与最高四分位数的候选人相比，调整后的移植率低38%（sHR：0.62，95% CI：0.57-0.68）。移植后1年生存率无显著差异。虽然主要分配单位的扩大改善了等待名单结果的差异，但移植后生存率没有任何变化，但由于地理原因，仍然存在显着差异。
The primary lung allocation unit was expanded from the donation service area to a 250-mile radius in 2017. Prior to the change, geographic disparities in donor lung availability impacted waitlist outcomes. We sought to determine if the new allocation system improved these disparities. We conducted a retrospective cohort study comparing the 2-year period before and after the change. Donor lung availability was defined as the ratio of donor lungs to waitlist candidates in the primary allocation unit. Transplant centers were divided into quartiles by donor lung availability. Multivariable competing risk models were used to determine the association between lung availability and waitlist outcomes. Multivariable Cox proportional hazards models compared post-transplant survival. Prior to the allocation change, the unadjusted transplant rate at centers in the lowest and highest quartiles was 132 and 607 transplants per 100 waitlist years. Candidates in the lowest quartile of donor lung availability had a 61% adjusted lower transplantation rate compared to candidates in highest quartile (sub-hazard ratio [sHR]: 0.39, 95% confidence interval [CI]: 0.34-0.44). After the allocation change, the disparity decreased resulting in an unadjusted transplant rate of 141 and 309 among centers in the lowest and highest quartiles. Candidates in the lowest quartile had a 38% adjusted lower transplantation rate compared to those in the highest (sHR: 0.62, 95% CI: 0.57-0.68). There was no significant difference in 1-year post-transplant survival. Although the expansion of the primary allocation unit improved disparities in waitlist outcomes without any change in post-transplant survival, there still remain significant differences due to geography.
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影响因子：
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通讯作者：
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影响因子：
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