美国人口规模和成年人肝移植等待名单的结果
Tomohiro Tanaka1,2,3, George Wehby2,3,4,5, Mark Vander Weg3,6
1Division of Gastroenterology and Hepatology, University of Iowa Carver College of Medicine, Iowa City.
JAMA network open
|March 25, 2025
概括
肝移植等候名单死亡率在人口较少的地区较高,对于患有高末期肝病 (MELD) 模型得分的重症患者. 固定距离分配圈可能会产生新的差异,突出需要基于人口的调整.
科学领域:
- 移植医学 移植医学
- 医疗保健服务研究 医疗服务研究
- 器官分配政策 器官分配政策
背景情况:
- 在以优先分数为基础的肝移植 (LT) 分配系统中存在地理不平等.
- 目前的敏度圈 (AC) 系统使用固定的距离,这可能无法确保人口的公平分配.
- 这可能会在器官分配中引入新的差异.
研究的目的:
- 评估围绕LT中心的人口规模与等待列表结果之间的关联.
- 专注于患有慢性末期肝病和高末期肝病模型 (MELD) 评分或急性肝衰竭 (ALF) 的重症患者.
- 评估在AC分配后的时代的差异.
主要方法:
- 从2013年6月到2023年5月,美国全国对成年LT候选人的回顾性队列研究.
- 使用一般化的线性混合效应模型和细灰竞争风险回归分析等待名单死亡率和学率.
- 分为AC前和AC后时代的分层,以半径定义的人口规模 (高MELD为150nm,ALF为500nm).
主要成果:
- 在AC时代的高MELD队列中,在人口最低的中心列出名单与死亡率增加有关 (AOR,1.68).
- 人口数量增加一倍与死亡率或学率减少34%相关 (AOR,0.66).
- 在ALF队列中没有发现与人口密度相关的显著差异.
结论:
- 在人口较少的地区被列入等待名单与患重病的LT候选人的死亡率较高,MELD得分较高.
- 这些发现强调了仅依靠固定距离的分配系统的局限性.
- 对分配策略进行重新评估以考虑人口分布是合理的.
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