Gender disparities in liver transplant: Examining organ acceptance patterns

 描述(申请人提供)：肝移植是终末期肝病(ESLD)患者的唯一挽救生命的治疗方法。不幸的是，许多被列入移植名单的患者将因病情太重而无法移植，或者在等待器官移植时死亡。鉴于……的严重性 未能接受肝脏移植的后果已经作出努力，以建立一个公平和公平的分配制度。2002年，根据患者的INR、肌酐和胆红素得出的终末期肝病模型(MELD)评分被实施，考虑到这些目标。MELD评分减少了等待时间和总的等待名单死亡率。然而，在2008年，在肝移植中发现了令人不安的性别差异。在MELD时代，女性比男性更有可能病得太重或死在移植名单上，而接受肝移植的可能性比男性小。这一领域的研究发现，肌酐和体型的性别差异是重要的促成因素。然而，这两个假设都不能完全解释移植成功率的差异。移植中的性别差异是复杂和多因素的；它涉及供者、受者和中心因素。为了进一步了解这些因素，应该探索器官捐献和接受模式的性别差异。我们研究的目标1将寻求确定器官捐献是否存在性别差异。接受器官捐赠完全是基于一个人的MELD评分和血型。我们假设女性会有较低的肌酐，因此MELD评分也会较低。这将转化为女性接受的器官捐赠比男性少。在目标2中，我们将探索器官接受模式的性别差异。为了让患者接受移植，移植团队必须提供器官并接受移植。移植团队接受或拒绝器官的决定是一个复杂的决定。要弄清移植过程中性别差异的症结所在，我们需要探索这些复杂性。最后，我们认为供受者大小匹配是移植团队决定接受或拒绝器官的一个重要因素。在目标3中，我们将通过探索器官因大小而减少的比率的差异，来探索大小匹配是否对女性不利。拟议的研究项目将在申请者努力攻读临床流行病学理学硕士学位的背景下进行，在课堂上进行教学，重点是流行病学基础知识、研究设计以及研究的统计和分析方法，将加强和指导申请者的研究过程。申请者对这个项目的长期目标是收集和分析数据，准备出版手稿，并将这些数据作为未来K奖申请的一部分。

 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.