Addressing Geographic Disparities in Liver Transplantation Through Redistricting

作者：Gentry S E; Massie A B; Cheek S W; Lentine K L; Chow E H; Wickliffe C E; Dzebashvili N; Salvalaggio P R; Schnitzler M A; Axelrod D A; Segev D L^*

来源：American Journal of Transplantation, 2013, 13(8): 2052-2058.

DOI：10.1111/ajt.12301

• Broader sharing
• geographic disparities
• liver allocation
• Liver Simulated Allocation Model

Severe geographic disparities exist in liver transplantation; for patients with comparable disease severity, 90day transplant rates range from 18% to 86% and death rates range from 14% to 82% across donation service areas (DSAs). Broader sharing has been proposed to resolve geographic inequity; however, we hypothesized that the efficacy of broader sharing depends on the geographic partitions used. To determine the potential impact of redistricting on geographic disparity in disease severity at transplantation, we combined existing DSAs into novel regions using mathematical redistricting optimization. Optimizedmaps and current maps were evaluated using the Liver Simulated Allocation Model. Primary analysis was based on 6700 deceased donors, 28 063 liver transplant candidates, and 242 727 Model of End-Stage Liver Disease (MELD) changes in 2010. Fully regional sharing within the current regional map would paradoxically worsen geographic disparity (variance in MELD at transplantation increases from 11.2 to 13.5, p = 0.021), although it would decrease waitlist deaths (from 1368 to 1329, p = 0.002). In contrast, regional sharing within an optimized map would significantly reduce geographic disparity (to 7.0, p = 0.002) while achieving a larger decrease in waitlist deaths (to 1307, p = 0.002). Redistricting optimization, but not broader sharing alone, would reduce geographic disparity in allocation of livers for transplant across the United States.

• 出版日期2013-8
• 单位中国人民解放军海军大连舰艇学院