Gender disparities in liver transplant: Examining organ acceptance patterns

 描述（由申请人提供）：肝移植是终末期肝病（ESLD）患者的唯一救命治疗方法。不幸的是，许多被列入移植名单的患者在等待器官移植时病情过重或死亡。考虑到 未能接受肝脏移植的后果已作出努力，以建立一个公平合理的分配制度。在2002年，终末期肝病模型（MELD）评分，这是从患者的INR，肌酐和胆红素得出的，考虑到这些目标。MELD评分降低了等待时间和总体等待名单死亡率。然而，在2008年，发现了肝移植中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变得过于虚弱或死亡，并且比男性更不可能接受肝移植。这一领域的研究已经确定肌酐和体型的性别差异是重要的影响因素。然而，这两种假设都不能完全解释接受移植率的差异。移植中的性别差异是复杂和多因素的;它涉及供体，受体和中心因素。为了进一步了解这些因素的性别差异，器官提供和接受模式应进行探讨。我们研究的目标1将试图确定器官捐献是否存在性别差异。接受器官捐献完全基于MELD分数和血型。我们假设女性的肌酐较低，因此MELD评分较低。这将意味着女性获得的器官捐赠比男性少。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一个器官是一个复杂的决定。要找到移植中性别差异的症结，就需要我们探索这些复杂性。最后，我们相信当移植团队决定接受或拒绝一个器官时，供体与受体的大小匹配是一个重要因素。在目标3中，我们将通过探索由于尺寸而导致的器官衰退率的差异来探索尺寸匹配是否不成比例地对女性不利。拟议的研究项目将在申请人致力于临床流行病学硕士学位的背景下进行，从而在课堂上进行教学式学习，重点关注流行病学的基础知识，研究设计以及研究的统计和分析方法，将增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，并将数据作为未来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.