Identifying determinants of access to the early steps of liver transplant in the Southeast

项目摘要/摘要 在美国，肝硬变是一个主要的公共卫生问题，影响到大约450万患有 生活贫困和有医疗补助保险的人中的流行率增加。失代偿性肝硬化， 也称为终末期肝病(ESLD)，当患者开始经历 肝硬变，包括腹水、静脉曲张出血和脑病，约有20万例和50,000例 美国每年的死亡人数。对于ESLD患者，肝移植是唯一的治愈选择。在……里面 2021年，美国大约有9000例肝脏移植。移植是一个复杂的、多步骤的 从ESLD诊断开始的过程，需要转诊到高度专业化的移植中心。这是 然后完成紧张的、全面的医疗和心理社会评估进程，如果被选中， 被列入全国已故肝脏捐赠者的等待名单。一旦病人被列入等候名单，他们就会 由器官共享联合网络(UNOS)监测，该网络监测移植机会的公平性 对于已故捐赠者等待名单上的患者，以及移植后的结果。当进入肝脏时 一旦等待移植是相对公平的，在种族、社会经济和地理上的差异 等待名单。由于数据的限制，肝移植早期步骤的潜在差异(即转诊和 评估)，这可能会导致观察到的等待名单差异仍不清楚。使用来自两个肝脏的数据 为佐治亚州、阿拉巴马州、田纳西州和南卡罗来纳州108个县地区提供服务的移植中心 埃默里和皮埃蒙特(亚特兰大集水区)，结合患者和提供者的访谈，建议 应用程序将确定影响获得肝移植转诊和ESLD评估的关键因素 东南部的病人。这项工作将为未来的R01应用程序提供信息，以开发和测试对 增加该地区肝脏移植早期步骤的公平性。指导团队，瑞秋博士 Patzer(主要导师)、Dio Kavalieratos(联合导师)和Raymond Lynch(联合导师)代表着一个组合 在移植流行病学、临床肝移植、卫生服务研究和 定性与混合的研究方法。通过This K01提供的培训，Ross-Driscoll博士将 获得更多有关肝移植临床方面的知识，以及空间方法学技能。 流行病学、定性研究和干预发展。科研与培训相结合 这项K01奖项提供的支持将使她能够在之前肝移植经验的基础上再接再厉， 流行病学和卫生服务研究，成为肝脏移植领域的专家。

Project Summary / Abstract Cirrhosis is a major public health problem in the United States, affecting approximately 4.5 million people with increased prevalence among persons living in poverty and insured by Medicaid. Decompensated cirrhosis, also called end-stage liver disease (ESLD), occurs when patients begin to experience major complications of cirrhosis, including ascites, variceal bleeding, and encephalopathy, with ~200,000 incident cases and 50,000 deaths in the U.S. each year. For patients with ESLD, liver transplant is the only curative treatment option. In 2021, there were approximately 9,000 liver transplants in the U.S. Transplantation is a complex, multistep process that begins at ESLD diagnosis and requires referral to a highly specialized transplant center. This is followed by completion of an intense, holistic medical and psychosocial evaluation process, and, if selected, being placed on the national waiting list for a deceased donor liver. Once patients are waitlisted, they are surveilled by the United Network for Organ Sharing (UNOS), which monitors equity in access to transplantation for patients on the deceased donor waiting list in addition to post-transplant outcomes. While access to liver transplant once waitlisted is relatively equitable, there are racial, socioeconomic, and geographic disparities in waitlisting. Because of data limitations, potential disparities in earlier steps to liver transplant (i.e. referral and evaluation) that may lead to observed differences in waitlisting remain unknown. Using data from two liver transplant centers serving a 108-county region in Georgia, Alabama, Tennessee and South Carolina served by Emory and Piedmont (Atlanta catchment area), combined with patient and provider interviews, the proposed application will identify key factors that influence access to liver transplant referral and evaluation for ESLD patients in the Southeast. This work will inform a future R01 application to develop and test an intervention to increase equity in access to the early steps of liver transplant in this region. The mentoring team, Drs. Rachel Patzer (primary mentor), Dio Kavalieratos (co-mentor) and Raymond Lynch (co-mentor), represent a combined wealth of expertise in transplant epidemiology, clinical liver transplantation, health services research, and qualitative and mixed methods research. Through the training provided by this K01, Dr. Ross-Driscoll will obtain additional knowledge of clinical aspects of liver transplantation, and methodological skills in spatial epidemiology, qualitative research and intervention development. The combination of research and training support provided by this K01 award will allow her to build on her previous experience in liver transplantation, epidemiology, and health services research to become an expert in the field of liver transplant access.