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The Impact of Primary Liver Disease and Social Determinants in a Mixed Donor Liver Transplant Program: A Single-Center Analysis.
Leung, Kristel K; Kim, Audrey; Hansen, Bettina E; Lilly, Les; Selzner, Nazia; Patel, Keyur; Bhat, Mamatha; Hirschfield, Gideon M; Galvin, Zita.
Afiliação
  • Leung KK; Division of Gastroenterology & HepatologyDepartment of MedicineUniversity of TorontoTorontoOntarioCanada.
  • Kim A; Multi-Organ Transplant ProgramDepartment of MedicineToronto General HospitalTorontoOntarioCanada.
  • Hansen BE; Institute of Health Policy, Management and EvaluationUniversity Health Network, University of TorontoTorontoOntarioCanada.
  • Lilly L; Toronto Centre for Liver DiseaseUniversity Health Network, University of TorontoTorontoOntarioCanada.
  • Selzner N; Division of Gastroenterology & HepatologyDepartment of MedicineUniversity of TorontoTorontoOntarioCanada.
  • Patel K; Multi-Organ Transplant ProgramDepartment of MedicineToronto General HospitalTorontoOntarioCanada.
  • Bhat M; Division of Gastroenterology & HepatologyDepartment of MedicineUniversity of TorontoTorontoOntarioCanada.
  • Hirschfield GM; Multi-Organ Transplant ProgramDepartment of MedicineToronto General HospitalTorontoOntarioCanada.
  • Galvin Z; Division of Gastroenterology & HepatologyDepartment of MedicineUniversity of TorontoTorontoOntarioCanada.
Liver Transpl ; 27(12): 1733-1746, 2021 12.
Article em En | MEDLINE | ID: mdl-34092028
ABSTRACT
Organ allocation in liver transplantation (LT) remains imperfect. Periodic center reviews ensure programs transparently evaluate the impact of practice on access to transplantation, reflecting, in particular, patient (primary disease, social determinants) and program (deceased versus live donation) factors. Adult Ontario residents waitlisted for first LT at Toronto General Hospital from November 2012 to May 2019 were reviewed. Analyses were performed between distance to transplant center, income, education level, population density and primary liver disease, with LT, deceased donor liver transplant (DDLT), living donor liver transplant (LDLT), and delisting. Of 1735 listed patients, 549 were delisted (32%), while 1071 were transplanted (62%), with 819 DDLT recipients (76%) and 252 LDLT recipients (24%), while 115 (7%) remained actively listed at data census. On univariate analysis, DDLT recipients lived 30% closer (median 39.7 versus 60.6 km; P < 0.001), lived in more populous areas (median 8501.0 versus 6868.5 people in a 1-km radius; P < 0.001), and resided in households that annually earned 10% less (median $92,643.17 versus $102,820.89 Canadian dollars; P < 0.001) compared with LDLT recipients. These findings with population density and income differences between DDLT versus LDLT receival remained significant on multivariate modeling even when accounting for primary liver disease. Primary liver disease was a statistically significant factor on multivariate analyses in LT receival (P = 0.001) as well as DDLT versus LDLT receival (P < 0.001). Of patients listed for end-stage liver disease, more patients with autoimmune cholestatic liver diseases received LDLT (34%-41%) than DDLT (27%-30%); this contrasted with patients with noncholestatic diseases LDLT (8%-19%) versus DDLT (37%-59%) receival (P < 0.001). Review of transplant allocation in a large mixed-donor North American liver transplant program demonstrates how patient social determinants and primary liver disease etiology continue to be significantly associated with ultimate transplantation.
Assuntos

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Transplante de Fígado / Hepatopatias Tipo de estudo: Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Adult / Humans País/Região como assunto: America do norte Idioma: En Ano de publicação: 2021 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Transplante de Fígado / Hepatopatias Tipo de estudo: Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Adult / Humans País/Região como assunto: America do norte Idioma: En Ano de publicação: 2021 Tipo de documento: Article