亚洲人群肝移植可及性和患者生存率:共享前35 vs共享后35

Yefei Zhang
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引用次数: 4

摘要

背景:关于亚洲人群肝移植的种族差异和趋势的研究很少。目的:探讨Share 35政策自2013年6月实施以来对亚洲患者获得肝移植和预后的影响。方法:从美国器官共享网络数据库中检索2012年至2015年间登记的11910例死亡供肝移植的成年白人和亚洲患者。采用Logistic回归和比例风险模型,调整人口统计学、临床和地理因素,对肝移植的可及性和患者生存进行建模。对Share 35前后时期进行分层,将Share 35政策的前18个月与等效时期进行比较。结果:share 35前后的比较显示,亚洲患者的等待时间显著减少,接受肝移植的患者比例更高。亚洲人的移植率与白人相似(OR: 1.15, 95% CI: 0.80-1.67),但在Share 35政策生效后,他们在接受肝移植前的等待时间明显更长(HR: 0.56, 95% CI: 0.34-0.92)。在移植后18个月的结果中,亚洲人和白人之间没有观察到明显的生存差异。结论:尽管受益于Share 35政策,但亚洲患者在获得肝移植方面仍面临更大的风险差异。
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Access to Liver Transplantation and Patient Survival among Asian Populations: Pre-Share 35 vs Post-Share 35
Background: Studies addressing ethnic disparities and trends in liver transplantation for Asian population are scant. Objective: To examine the impact of Share 35 policy on Asian patients’ access to liver transplantation and outcomes since its implementation in June 2013. Methods: A total of 11,910 adult white and Asian patients who were registered for deceased donor liver transplantation between 2012 and 2015, was identified from the United Network for Organ Sharing database. Logistic regression and proportional hazard models with adjustment for demographic, clinical and geographic factors were used to model the access to liver transplantation and patient survival. Stratification on pre- and post-Share 35 periods was performed to compare the first 18 months of Share 35 policy to an equivalent period. Results: Comparison of the pre- and post-Share 35 periods showed a significant decrease in time on waiting list and higher proportions of patients receiving liver transplantation for Asian patients. Asians shared similar transplant rates as whites (OR: 1.15, 95% CI: 0.80–1.67) but experienced significantly longer waiting time (HR: 0.56, 95% CI: 0.34–0.92) before they received liver transplantation after Share 35 policy took effect. No significant post-transplantation survival difference was observed between Asians and whites at the 18-month outcome. Conclusion: Although benefited from the Share 35 policy, Asian patients are still at greater risk of disparities in access to liver transplantation.
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来源期刊
CiteScore
1.60
自引率
0.00%
发文量
0
审稿时长
12 weeks
期刊介绍: The International Journal of Organ Transplantation Medicine (IJOTM) is a quarterly peer-reviewed English-language journal that publishes high-quality basic sciences and clinical research on transplantation. The scope of the journal includes organ and tissue donation, procurement and preservation; surgical techniques, innovations, and novelties in all aspects of transplantation; genomics and immunobiology; immunosuppressive drugs and pharmacology relevant to transplantation; graft survival and prevention of graft dysfunction and failure; clinical trials and population analyses in the field of transplantation; transplant complications; cell and tissue transplantation; infection; post-transplant malignancies; sociological and ethical issues and xenotransplantation.
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