Gender disparities in liver transplant: Examining organ acceptance patterns

肝移植中的性别差异：检查器官接受模式

• 批准号: 9263688
• 负责人: Lauren Nephew
• 金额: $ 2.08万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-04-01 至 2017-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9263688
• 关键词: Address; Adult; Area; Bilirubin; Blood; Complex; Creatinine; Data; Disadvantaged; Disease; Female; Force of Gravity; Future; Gender; Goals; Height; K-Series Research Career Programs; Learning; Life; Liver; Liver diseases; Logistic Regressions; Manuscripts; Master of Science; Measures; Mind; Modeling; Nonprofit Organizations; Organ; Organ Transplantation; Patients; Pattern; Policies; Positioning Attribute; Privatization; Process; Public Health; Publications; Research; Research Design; Research Methodology; Research Project Grants; Resources; Retrospective cohort study; Role; Running; Savings; Serum; Services; Social Justice; Statistical Methods; System; Time; Training; Translating; Transplantation; United Network for Organ Sharing; Waiting Lists; Woman; Work; analytical method; base; body system; clinical epidemiology; data sharing; design; epidemiology study; gender difference; gender disparity; improved; liver transplantation; male; men; mortality; organ allocation; programs; public health relevance; tool

 DESCRIPTION (provided by applicant): Liver transplantation is the sole life-saving treatment for patients with end stage liver disease (ESLD). Unfortunately many patients listed for transplant will become too sick for transplant or die while awaiting an organ. Given the gravity of the consequences of failing to receive a liver transplant efforts have been made to establish an allocation system that is equitable and fare. In 2002, the Model for End Stage Liver Disease (MELD) score, which is derived from a patient's INR, creatinine, and bilirubin was implemented, with these goals in mind. The MELD score has decreased wait time and overall waitlist mortality. However in 2008 a disturbing gender disparity in liver transplantation was identified. I the MELD era women are more likely than men to become too sick or die on the transplant list and less likely than men to receive liver transplantation. Research in this area has identified gender differences in creatinine and size as important contributing factors. However neither of these hypotheses has fully explained the disparity in rates of receiving a transplant. The gender disparity in transplantation is complex and multifactorial; it involves donor, recipient, and cente factors. To further understand these factors gender differences in organ offer and acceptance patterns should be explored. Aim 1 of our study will seek to determine if there are gender differences in organ offers. Receiving an organ offer is based solely on ones MELD score and blood type. We hypothesize that women will have lower creatinine and therefor lower MELD scores. This will translate into women receiving fewer organ offers than men. In aim 2 we will explore gender difference in organ acceptance patterns. In order for a patient to receive a transplant, an organ must be offered and then accepted by the transplant team. A transplant team's decision to accept or decline an organ is a complex one. Getting at the crux of gender disparities in transplantation will require us to explore these complexities. Finally we believe tht donor- recipient size matching is an important factor when a transplant team decides to accept or decline an organ. In aim 3, we will explore if size matching disproportionately disadvantages women by exploring differences in rates of organs being declined because of size. The proposed research project will be in the context of the applicant working towards a Masters of Science in Clinical Epidemiology, whereby didactic learning in the classroom, focusing on fundamentals of epidemiology, study design, and statistical and analytic methods of research will enhance and guide the research process of the applicant. The long-term objectives of the applicant for this project are to collect and analyze the data, prepare manuscripts for publication and build upon the data as part of a future application for a K award.

 描述（由适用提供）：肝移植是针对末期肝病（ESLD）患者的唯一挽救生命治疗。不幸的是，许多接受移植的患者在等待器官时会因移植或死亡而生病。鉴于重力 未能接受肝移植努力的后果是为了建立公平且票价的分配系统。在2002年，实施了这些目标，该模型源自患者的INR，肌酐和胆红素，该模型源自患者的INR，肌酐和胆红素。 MELD得分降低了等待时间和整体等待表的死亡率。但是，在2008年，肝移植中的性别差异令人不安的是，我的梅尔德时代女性比男性更有可能生病或死于移植清单，而比男性接受肝移植的可能性较小。该领域的研究确定了肌酐和大小的性别差异是重要的因素。但是，这些假设都没有充分解释接受移植的率的差异。移植中的性别差异是复杂且多因素的。它涉及捐助者，接受者和百分位因素。为了进一步了解这些因素，应探讨器官报价和接受模式的性别差异。我们研究的目标1将寻求确定器官报价是否存在性别差异。接收器官优惠仅基于梅尔德评分和血型。我们假设女性的肌酐将较低，因此MELD得分较低。这将转化为女性收到的器官报价少于男性。在AIM 2中，我们将探讨器官接收模式中的性别差异。为了使患者接受移植，必须提供器官，然后被移植小组接受。移植团队接受或拒绝器官的决定是一个复杂的人。在移植中获得性别分布的关键，将要求我们探索这些复杂性。最后，我们认为，当移植团队决定接受或拒绝器官时，捐助者的大小匹配是一个重要因素。在AIM 3中，我们将通过探索由于尺寸而降低的器官率差异来探索尺寸是否与不成比例的妇女匹配。拟议的研究项目将在临床流行病学科学硕士学位的应用下进行，在课堂上进行教学学习，重点介绍流行病学，研究设计以及研究的统计和分析方法的基础知识，将增强和指导该项目的长期目标，以收集和分析数据，以促进和分析数据，以促进一定的数据，并构建了一定的数据，并构建了一定的数据，并构建了一定的数据。