科研之友
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摘要
Background. The provision of effective surgical care for end-stage renal disease (ESRD) requires efficient evaluation and transplantation. Prior assessments of transplant access have focused primarily on waitlisted patients rather than the overall populations served by %26quot;accountable%26quot; providers of transplant services. %26lt;br%26gt;Methods. Novel transplant referral regions (TRRs) were defined using United Network for Organ Sharing registry data for 301,092 kidney transplant listings to assign zip codes to %26quot;accountable%26quot; transplant programs. Subsequently, risk-adjusted observed to expected (0:E) rates of listing and transplant procedures were calculated for each TRR. Finally, the impact of variation in TRR listing and transplant rates on mortality was, assessed for ESRD patients %26lt;60 years old diagnosed between 2000 and 2008. %26lt;br%26gt;Results. In total, 113 TRRs were defined, 51% of which included %26gt;1 transplant center The likelihood of being evaluated and listed for transplant varied significantly between TRRs (risk-adjusted 0:E, 0.58-1.95). Variation was greater for the overall transplant rate (0.62-2.19), living donor transplantation (0.36-3.08), and donation after cardiac death transplant (0-15.4) than for standard criteria donors (0.64-2.86). Mortality was decreased for ESRD patients living in TRRs in the highest tertile of listings (hazard ratio, 0.89; P %26lt;.0001) and transplantation (0.90; P %26lt;.0001). %26lt;br%26gt;Conclusion. Residence in a TRR with care delivery systems that increase access to transplant services is associated with significant, risk-adjusted decreases in ESRD-related mortality. Transplant centers should continue to focus on improving access to care within the communities they serve.
- 出版日期2014-5
