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: 9051217
• 负责人: Lauren Nephew
• 金额: $ 6.45万
• 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 2017-10-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9051217
• 关键词: Accounting; Address; Adult; Area; Bilirubin; Blood typing procedure; Cohort Studies; Complex; Creatinine; Data; Data Analyses; Disadvantaged; Disease; Female; Force of Gravity; Future; Gender; Goals; Height; K-Series Research Career Programs; Lead; Learning; Life; Liver; Liver diseases; Logistic Regressions; Manuscripts; Master of Science; Measures; Mind; Modeling; Nonprofit Organizations; Organ; Organ Transplantation; Patients; Pattern; Policies; Positioning Attribute; Process; Public Health; Publications; Research; Research Design; Research Methodology; Research Project Grants; Resources; Role; Running; Serum; Services; Sex Characteristics; Social Justice; Staging; System; Time; Training; Translating; Transplantation; United Network for Organ Sharing; Waiting Lists; Woman; Work; base; clinical epidemiology; data sharing; epidemiology study; 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（由申请人提供）：肝移植是终末期肝病 (ESLD) 患者的唯一挽救生命的治疗方法，许多被列入移植名单的患者不幸因病情严重而无法移植或在等待器官时死亡。 2002 年，针对未能接受肝移植的后果，建立了一个公平且收费的分配系统，建立了终末期肝病模型 (MELD) 评分，该评分源自患者的 INR、肌酐和肌酐。考虑到这些目标，MELD 评分降低了等待时间和总体等待死亡率，但在 2008 年，肝移植领域出现了令人不安的性别差异。在移植名单上，男性比男性更容易生病或死亡，并且比男性更不可能接受肝移植。该领域的研究已确定肌酐和体型的性别差异是重要的影响因素。然而，这些假设都没有充分解释这种差异。移植中的性别差异是复杂且多因素的；为了进一步了解器官提供和接受模式中的性别差异，我们将探讨这些因素。寻求确定是否接受器官捐献仅取决于 MELD 分数和血型。我们发现女性的肌酐较低，因此这将意味着女性接受的器官捐献较少。目标 2 我们将探讨器官接受模式的性别差异。为了让患者接受移植，必须提供器官，然后移植团队接受或拒绝器官的决定是一个复杂的决定。抓住性别的症结最后，我们认为，当移植团队决定接受或拒绝器官时，供体与受体的尺寸匹配是一个重要因素，我们将探讨尺寸匹配是否对女性不利。拟议的研究项目将在申请人攻读临床流行病学理学硕士学位的背景下探索，从而在课堂上进行教学学习，重点关注流行病学的基础知识和研究。设计、统计和分析方法将增强和指导申请人的研究过程。该项目申请人的长期目标是收集和分析数据，准备出版手稿，并以数据为基础。未来申请 K 奖的信息。