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

项目总结/摘要 由于器官短缺，超过15，000名终末期肝病（ESLD）患者正在等待 在美国，肝移植（LT）挽救了生命，但只有不到50%的等待患者会继续接受LT。 因此，每年有2,000多名LT等待名单上的患者死亡。种族差异加剧了器官 短缺：黑人人口中的ESLD率正在增加，但黑人患者不成比例地接受 与白色患者相比，LT更少。2活体肝移植（LDLT）是一种安全有效的治疗方法， 增加LT的器官可用性。3然而，黑人ESLD患者接受不到10%的LDLT。努力 迫切需要纠正这些差距。 评估影响黑人潜在LT受体（LTR）沿着潜在活肝的多层次因素 在制定干预措施以促进平等获得LDLT方面，与捐助方（LDs）的合作至关重要。特别是， 了解健康的社会决定因素（SDOH）如何调解获得LDLT的种族差异， 在获得LDLT方面存在严重障碍，因为与SDOH相关的障碍集中在少数种族。 很少有回顾性研究确定了与LDLT获得差异相关的患者水平因素 (e.g.,到移植中心的距离、保险和社区收入）。了解的机制 在移植和供体选择过程中潜在LLD和LTR经历之间的相互作用 对于有效地针对旨在改善捐助者和 接受者的经验。 拟议研究的目的是评估多层次因素造成的差距， 获得LT等待名单和LDLT的黑人ESLD患者和潜在的LLD。在这个描述性的 在一项研究中，我们将比较两个移植中心的黑人和白色患者接受LT和LDLT的情况， 大量黑人ESLD患者人群（纳什维尔，TN和达勒姆，北卡罗来纳州）。我们会让LDLT 利益相关者（即，潜在的LTR、潜在的LLD和移植临床医生）以识别多层次障碍， 促进者，以及使用混合方法克服LT和LDLT障碍的策略。我们将利用 研究结果，以制定旨在促进LT和LDLT公平的干预措施，并使用 执行科学。具体目标是： 1.评估中心记录的导致LT和LDLT种族差异的多水平因素 2.描述患者感知的影响LT和LDLT获取的多水平因素 3.评估导致LT和LDLT种族差异的多层次因素之间的相互作用 研究结果将为建立一个具有文化敏感性的、多层次的、以移植中心为基础的 干预，以增加黑人患者获得LDLT，并挽救生命。

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.