Assessing Multi-level Barriers to Racial Equity in Living Liver Donor Transplantation

项目摘要/摘要 由于器官短缺，超过1.5万名终末期肝病(ESLD)患者正在等待 挽救生命的肝移植(LT)在美国，但只有不到50%的等待名单的患者将继续接受LT.1 因此，每年有超过2,000名等待LT的患者死亡。种族差异使器官变得复杂 短缺：ESLD在黑人人口中的发病率正在上升，但黑人患者接受的比例不成比例 活体供肝移植(LDLT)是一种安全有效的治疗方法 增加了LT的器官利用率。3然而黑人ESLD患者接受的LDLT不到10%。努力实现 纠正这些差距是迫切需要的。 评估影响黑色潜在性移植受体(LTR)和潜在活体肝脏的多水平因素 捐助者对于制定干预措施以促进获得最不发达国家的公平至关重要。特别是， 了解健康的社会决定因素(SDOH)如何调节获得LDLT的种族差异是一项 由于与SDOH有关的障碍集中在少数族裔中，因此在获得LDLT方面存在着严重的公平障碍。 很少有回溯性研究确定患者水平的因素与接受LDLT的机会差异有关 (例如，到移植中心的距离、保险和社区收入)。了解以下机制： 移植和供体选择过程中潜在的LLD和LTR经验之间的相互作用 对于有效针对旨在改善捐赠者和受赠者获得LDLT的机会的干预措施至关重要 接受者体验。 这项拟议研究的目的是评估导致不同性别差异的多层次因素 对于患有ESLD和潜在LLD的黑人患者，可以使用LT等待名单和LDLT。在这本描述性的 研究中，我们将比较两个移植中心的黑人和白人患者接受同种异体肝移植和同种异体同种异体肝移植的机会 大量黑人ESLD患者(田纳西州纳什维尔和北卡罗来纳州达勒姆)。我们将与LDLT交战 利益相关者(即潜在的LTR、潜在的LLD和移植临床医生)，以确定多级障碍， 促进者，以及使用混合方法克服LT和LDLT障碍的战略。我们将利用 制定旨在促进LT和LDLT公平的干预措施，并评估其可行性 实施科学。具体目标是： 1.评估中心记录的导致LT和LDLT中种族差异的多层次因素 2.描述影响接受LT和LDLT的患者感知的多层次因素 3.随着时间的推移，评估造成LT和LDLT种族差异的多层次因素之间的相互作用 研究结果将为以文化敏感、多层次、以移植中心为基础的发展提供信息 采取干预措施，增加黑人患者获得LDLT的机会，并拯救生命。

PROJECT SUMMARY/ABSTRACT Due to the organ shortage, more than 15,000 patients with end-stage liver disease (ESLD) are waiting for a life-saving liver transplant (LT) in the US, but fewer than 50% of waitlisted patients will go on to receive a LT.1 As a result, more than 2,000 LT waitlisted patients die each year. Racial disparities compound the organ shortage: ESLD rates are increasing in the Black population, but Black patients receive disproportionately fewer LTs than White patients.2 Living donor liver transplantation (LDLT) is a safe and effective treatment that increases organ availability for LT.3 Yet Black ESLD patients receive fewer than 10% of LDLTs. Efforts to redress these disparities are urgently needed. Assessing multilevel factors that affect Black potential LT recipients (LTR) along with potential living liver donors (LLDs) is essential for developing interventions that foster equity in access to LDLT. In particular, understanding how social determinants of health (SDOH) mediate racial disparities in access to LDLT is a critical barrier to equity in access to LDLT because SDOH-related barriers are concentrated in racial minorities. Few retrospective studies have identified patient-level factors associated with disparities in access to LDLT (e.g., distance to transplant center, insurance, and neighborhood income). Understanding the mechanisms of the interaction between potential LLD and LTR experiences during the transplant and donor selection process is critical to effectively targeting interventions designed to improve access to LDLT to both the donor and recipient experiences. The objective of the proposed study is to assess multilevel factors contributing to disparities in access to the LT waitlist and LDLT for Black patients with ESLD and potential LLDs. In this descriptive study, we will compare access to LT and LDLT among Black and White patients at two transplant centers with large Black ESLD patient populations (Nashville, TN, and Durham, North Carolina). We will engage LDLT stakeholders (i.e., potential LTRs, potential LLDs, and transplant clinicians) to identify multilevel barriers, facilitators, and strategies for overcoming barriers to LT and LDLT using mixed methods. We will leverage findings to develop an intervention designed to foster equity in LT and LDLT, and assess its feasibility using implementation science. The specific aims are to: 1. Assess center documented multi-level factors contributing to racial disparities in LT and LDLT 2. Characterize patient perceived multi-level factors that influence access to LT and LDLT 3. Assess the interaction between multilevel factors contributing to racial disparities in LT and LDLT over time Study results will inform the development of a culturally sensitive, multilevel, transplant center-based intervention to increase Black patients’ access to LDLT, and to save lives.