Gender disparities in liver transplant: Examining organ acceptance patterns

肝移植中的性别差异：检查器官接受模式

• 批准号: 9263688
• 负责人: Lauren Nephew
• 金额: $ 2.08万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-04-01 至 2017-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9263688
• 关键词: Address; Adult; Area; Bilirubin; Blood; Complex; Creatinine; Data; Disadvantaged; Disease; Female; Force of Gravity; Future; Gender; Goals; Height; K-Series Research Career Programs; Learning; Life; Liver; Liver diseases; Logistic Regressions; Manuscripts; Master of Science; Measures; Mind; Modeling; Nonprofit Organizations; Organ; Organ Transplantation; Patients; Pattern; Policies; Positioning Attribute; Privatization; Process; Public Health; Publications; Research; Research Design; Research Methodology; Research Project Grants; Resources; Retrospective cohort study; Role; Running; Savings; Serum; Services; Social Justice; Statistical Methods; System; Time; Training; Translating; Transplantation; United Network for Organ Sharing; Waiting Lists; Woman; Work; analytical method; base; body system; clinical epidemiology; data sharing; design; epidemiology study; gender difference; gender disparity; improved; liver transplantation; male; men; mortality; organ allocation; programs; public health relevance; tool

 DESCRIPTION (provided by applicant): Liver transplantation is the sole life-saving treatment for patients with end stage liver disease (ESLD). Unfortunately many patients listed for transplant will become too sick for transplant or die while awaiting an organ. Given the gravity of the consequences of failing to receive a liver transplant efforts have been made to establish an allocation system that is equitable and fare. In 2002, the Model for End Stage Liver Disease (MELD) score, which is derived from a patient's INR, creatinine, and bilirubin was implemented, with these goals in mind. The MELD score has decreased wait time and overall waitlist mortality. However in 2008 a disturbing gender disparity in liver transplantation was identified. I the MELD era women are more likely than men to become too sick or die on the transplant list and less likely than men to receive liver transplantation. Research in this area has identified gender differences in creatinine and size as important contributing factors. However neither of these hypotheses has fully explained the disparity in rates of receiving a transplant. The gender disparity in transplantation is complex and multifactorial; it involves donor, recipient, and cente factors. To further understand these factors gender differences in organ offer and acceptance patterns should be explored. Aim 1 of our study will seek to determine if there are gender differences in organ offers. Receiving an organ offer is based solely on ones MELD score and blood type. We hypothesize that women will have lower creatinine and therefor lower MELD scores. This will translate into women receiving fewer organ offers than men. In aim 2 we will explore gender difference in organ acceptance patterns. In order for a patient to receive a transplant, an organ must be offered and then accepted by the transplant team. A transplant team's decision to accept or decline an organ is a complex one. Getting at the crux of gender disparities in transplantation will require us to explore these complexities. Finally we believe tht donor- recipient size matching is an important factor when a transplant team decides to accept or decline an organ. In aim 3, we will explore if size matching disproportionately disadvantages women by exploring differences in rates of organs being declined because of size. The proposed research project will be in the context of the applicant working towards a Masters of Science in Clinical Epidemiology, whereby didactic learning in the classroom, focusing on fundamentals of epidemiology, study design, and statistical and analytic methods of research will enhance and guide the research process of the applicant. The long-term objectives of the applicant for this project are to collect and analyze the data, prepare manuscripts for publication and build upon the data as part of a future application for a K award.

 描述（由申请人提供）：肝移植是终末期肝病（ESLD）患者唯一的挽救生命的治疗方法。不幸的是，许多列入移植名单的患者会因病情太重而无法移植，或者在等待器官时死亡。鉴于重力 未能接受肝移植的后果已经做出努力，建立公平和票价公平的分配制度。 2002 年，考虑到这些目标，实施了终末期肝病模型 (MELD) 评分，该评分源自患者的 INR、肌酐和胆红素。 MELD 分数减少了等待时间和总体候补死亡率。然而，2008 年，肝移植领域出现了令人不安的性别差异。在 MELD 时代，女性比男性更有可能在移植名单上病重或死亡，并且比男性接受肝移植的可能性更小。该领域的研究已确定肌酐和体型的性别差异是重要的影响因素。然而，这些假设都没有完全解释接受移植率的差异。移植中的性别差异是复杂的、多因素的；它涉及捐赠者、受赠者和中心因素。为了进一步了解这些因素，应探讨器官提供和接受模式中的性别差异。我们研究的目标 1 将试图确定器官提供是否存在性别差异。接受器官捐赠仅基于患者的 MELD 评分和血型。我们假设女性的肌酐较低，因此 MELD 分数较低。这将意味着女性接受的器官捐赠少于男性。在目标 2 中，我们将探讨器官接受模式的性别差异。为了让患者接受移植，必须提供器官，然后由移植团队接受。移植团队决定接受或拒绝器官是一项复杂的决定。要解决移植中性别差异的症结，我们需要探索这些复杂性。最后，我们认为，当移植团队决定接受或拒绝器官时，供体与受体的大小匹配是一个重要因素。在目标 3 中，我们将通过探索因尺寸而导致的器官退化率的差异，来探讨尺寸匹配是否对女性不利。拟议的研究项目将在申请人攻读临床流行病学理学硕士学位的背景下进行，课堂教学学习重点关注流行病学基础知识、研究设计以及统计和分析研究方法，将加强和指导申请人的研究过程。该项目申请人的长期目标是收集和分析数据，准备出版手稿，并以这些数据为基础，作为未来申请 K 奖的一部分。