Migration of Patients for Liver Transplantation and Waitlist Outcomes
Migration of Patients for Liver Transplantation and Waitlist Outcomes
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DOI：
10.1016/j.cgh.2019.04.060
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发表时间：
2019-10-01
影响因子：
12.6
通讯作者：
Kim, W. Ray
中科院分区：
文献类型：
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作者：
Kwong, Allison J.;Mannalithara, Ajitha;Kim, W. Ray
背景与目的：需要肝移植的患者可能会旅行以增加接受器官的机会。我们评估的因素，以确定哪些移植候选人前往其他地区，以增加他们的机会，接受肝脏和影响的旅行waitlist outcome.METHODS：我们进行了一项回顾性队列研究，所有成年患者登记为原发性死亡供体肝移植在美国从2004年1月至2016年12月。邮政编码数据用于计算从患者住所到他们在等待名单上或接受肝移植的中心的旅行距离。远距离上市和迁移被定义为分别在家庭移植区域之外和距离家庭邮政编码超过500英里的等待名单和接受肝移植。我们评估了结果（死亡和肝移植）和预测因素的远程上市或迁移使用多变量analysis.Results：有104,914候补登记在研究期间，其中2930（2.8%）追求上市在一个遥远的中心。在等待名单登记者中，60，985人接受了肝脏移植，其中1985人（3.3%）已经移民。在一项多变量竞争风险分析中，肝移植被视为竞争事件，远端列表与1年内死亡风险降低22%相关（亚危险比，0.78; 95%CI，0.70-0.88）。远距离上市和移民与非黑人种族，非医疗补助付款人，居住在一个较高收入的地区，并在高中以上的教育。结论：放置在肝移植等候名单以外的家庭移植区域与等待名单死亡率降低，接受肝移植的概率增加。获得肝移植的地理差异对少数民族、教育水平较低或有公共保险的患者产生了不成比例的影响。
BACKGROUND & AIMS: Patients in need of liver transplantation may travel to improve their chance of receiving an organ. We evaluated factors to determine which transplant candidates travel to other regions to increase their chances of receiving a liver and effects of travel on waitlist outcomes.METHODS: We performed a retrospective cohort study of all adult patients registered for primary deceased donor liver transplantation in the United States from January 2004 to December 2016. Zip code data were used to calculate the travel distance from a patient's residence to centers at which they were on the waitlist or received a liver transplant. Distant listing and migration were defined as placement on a waitlist and receipt of liver transplantation, respectively, outside the home transplantation region and greater than 500 miles from the home zip code. We assessed the effect of distant listing on outcomes (death and liver transplantation) and predictors of distant listing or migration using multivariable analyses.RESULTS: There were 104,914 waitlist registrations during the study period; of these, 2930 (2.8%) pursued listing at a distant center. Of waitlist registrants, 60,985 received liver transplants, of whom 1985 (3.3%) had migrated. In a multivariable competing risk analysis in which liver transplantation was considered as a competing event, distant listing was associated with a 22% reduction in the risk of death within 1 year (subhazard ratio, 0.78; 95% CI, 0.70-0.88). Distant listing and migration were associated with non-black race, non-Medicaid payer, residence in a higher income area, and education beyond high school.CONCLUSIONS: Placement on a liver transplant waitlist outside the home transplantation region is associated with reduced waitlist mortality and an increased probability of receiving a liver transplant. Geographic disparities in access to liver transplantation have disproportionate effects on patients who are minorities, have lower levels of education, or have public insurance.