Equity in liver transplantation: are we any closer?

IF 1.8 4区 医学 Q3 TRANSPLANTATION
Moronke Ogundolie, Norine Chan, Lisa M McElroy
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引用次数: 0

Abstract

Purpose of review: As policies governing liver transplantation (LT) continue to change and influence clinical practice, it is important to monitor trends in equitable access and outcomes amongst patients. The purpose of this review is to closely examine recent advances and findings in health equity research in LT over the last 2 years; specifically evaluating inequities at the different stages of LT (referral, evaluation, listing, waitlist outcomes and post-LT outcomes).

Recent findings: Advancements in geospatial analysis have enabled investigators to identify and begin to study the role of community level factors (such as neighborhood poverty, increased community capital/urbanicity score) in driving LT disparities. There has also been a shift in investigating center specific characteristics that contributes to disparities in waitlist access. Modification to the current model for end stage liver disease (MELD) score policy accounting for height differences is also crucial to eradicating the disparity in LT amongst sexes. Lastly, Black pediatric patients have been shown to have higher rates of death and worse posttransplant outcome after transitioning to adult healthcare.

Summary: Although, there have been some advances in methodology and policies, inequities in waitlist access, waitlist outcomes and posttransplant outcomes continue to be pervasive in the field of LT. Future directions include expansion of social determinants of health measures, inclusion of multicenter designs, MELD score modification and investigation into drivers of worse posttransplant outcomes in Black patients.

肝脏移植的公平性:我们离公平还有多远?
审查目的:随着肝移植(LT)政策的不断变化和对临床实践的影响,监测患者公平获得肝移植和肝移植结果的趋势非常重要。本综述旨在仔细研究过去两年中肝移植健康公平研究的最新进展和发现;特别是评估肝移植不同阶段(转诊、评估、列表、候诊结果和肝移植后结果)的不公平现象:地理空间分析的进步使研究人员能够识别并开始研究社区层面的因素(如邻里贫困、社区资本增加/城市化得分)在推动LT差异方面的作用。此外,调查中心的具体特征也发生了变化,这些特征导致了候补名单获取方面的差异。修改现行的肝病终末期模型(MELD)评分政策以考虑身高差异,对于消除不同性别间的LT差异也至关重要。最后,黑人儿科患者在过渡到成人医疗服务后,死亡率更高,移植后效果更差。总结:尽管在方法和政策方面取得了一些进展,但在等待名单获取、等待结果和移植后效果方面的不公平现象在LT领域仍然普遍存在。未来的发展方向包括:扩大健康社会决定因素的衡量范围、纳入多中心设计、修改 MELD 评分以及调查导致黑人患者移植后预后较差的原因。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
4.10
自引率
4.50%
发文量
124
审稿时长
6-12 weeks
期刊介绍: ​​​​​​Current Opinion in Organ Transplantation is an indispensable resource featuring key, up-to-date and important advances in the field from around the world. Led by renowned guest editors for each section, every bimonthly issue of Current Opinion in Organ Transplantation delivers a fresh insight into topics such as stem cell transplantation, immunosuppression, tolerance induction and organ preservation and procurement. With 18 sections in total, the journal provides a convenient and thorough review of the field and will be of interest to researchers, surgeons and other healthcare professionals alike.
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