背景:尽管西班牙裔患者有很高的终末期肝病和肝癌的发病率,肝移植(LT)提供最佳的长期结果,他们不太可能接受LT。对终末期肾病患者和肾移植患者的研究表明,文化相关的干预措施可以增加西班牙裔患者接受肾移植的可能性.然而,在潜在的LT候选人中,类似的干预措施在很大程度上仍未研究.
方法:比较了在实施有针对性的外展计划之前(2018年01月12日-2019年12月)和之后(2021年7月6日/2023年6月)转诊给德克萨斯州单一中心的西班牙裔患者人数。患者向LT进展,不合格的原因,并检查了两个时代之间的保险差异。
结果:在实施外展计划后,更多的西班牙裔患者被转诊为LT(23.2%vs26.2%,p=0.004)。比较前外展时代和后外展时代,更多的西班牙裔患者获得等候名单状态(分别为61vs78),接受LT971vs82).然而,接受LT的西班牙裔患者比例从30.2%降至20.3%.在后外展时代,一半的西班牙裔患者由于经济原因无法获得LT(112,50.5%).
结论:针对西班牙裔终末期肝病患者的针对性外展计划有效增加了西班牙裔LT转诊和受者的总数。然而,许多被转诊的患者不符合LT的条件,最常见的是经济原因。这些结果突显了在这个高需求社区中,需要对最有效的方法进行更多研究,以改善LT的财务障碍。
BACKGROUND: Although Hispanic patients have high rates of end-stage liver disease and liver cancer, for which liver transplantation (LT) offers the best long-term outcomes, they are less likely to receive LT. Studies of end-stage renal disease patients and kidney transplant candidates have shown that targeted, culturally relevant interventions can increase the likelihood of Hispanic patients receiving kidney transplant. However, similar interventions remain largely unstudied in potential LT candidates.
METHODS: Referrals to a single center in Texas with a large Hispanic patient population were compared before (01/2018-12/2019) and after (7/2021-6/2023) the implementation of a targeted outreach program. Patient progress toward LT, reasons for ineligibility, and differences in insurance were examined between the two eras.
RESULTS: A greater proportion of Hispanic patients were referred for LT after the implementation of the outreach program (23.2% vs 26.2%, p = 0.004). Comparing the pre-outreach era to the post-outreach era, more Hispanic patients achieved waitlisting status (61 vs 78, respectively) and received a LT (971 vs 82, respectively). However, the proportion of Hispanic patients undergoing LT dropped from 30.2% to 20.3%. In the post-outreach era, half of the Hispanic patients were unable to get LT for financial reasons (112, 50.5%).
CONCLUSIONS: A targeted outreach program for Hispanic patients with end-stage liver disease effectively increased the total number of Hispanic LT referrals and recipients. However, many of the patients who were referred were ineligible for LT, most frequently for financial reasons. These results highlight the need for additional research into the most effective ways to ameliorate financial barriers to LT in this high-need community.