Abstract:
BACKGROUND:A minority of liver transplantation (LT) candidates pursue listing at multiple centers to achieve transplantation. The purpose of this study was to assess the characteristics and outcomes of the migrated LT candidates, that is, those who travel to secondary centers seeking LT. STUDY DESIGN:Single-center retrospective study from January 1, 2005 to January 1, 2013 at a tertiary care center within United Network for Organ Sharing Region 1. Adult recipients who were listed at the primary center of interest, but subsequently achieved transplantation at a secondary center (Massachusetts General Hospital [MGH]-migrated; n = 44) were compared with recipients who achieved LT at the primary center (MGH-transplanted; n = 279). RESULTS:The MGH-migrated recipients most frequently traveled to United Network for Organ Sharing Region 3 (70.5%), with a mean (±SD) distance traveled of 1,134 (±392) miles. The MGH-migrated patients, when compared with MGH-transplanted recipients, spent more time on the waitlist (907.6 ± 930.1 days vs 354.9 ± 533.2 days; p < 0.00001), were more likely to have cholestatic liver disease (22.7% vs 6.8%; p = 0.0006) and private insurance (80.0% vs 51.6%; p = 0.0005), but were less likely to have alcoholic liver disease (2.3% vs 18.6%; p = 0.006) and Model for End-Stage Liver Disease exception points (6.8% vs 50.9%; p < 0.00001). On multivariable analysis, candidates with private insurance who lacked both alcoholic liver disease and Model for End-Stage Liver Disease exception point listing were significantly associated with the odds of pursuing migration. Despite achieving LT, MGH-migrated patients had inferior 5-year patient survival rates (63% vs 80%; p = 0.03). CONCLUSIONS:A small and distinctive cohort of LT recipients pursue migration to achieve transplantation. Travel patterns of migrated LT recipients appear to reflect the ongoing geographic disparities in liver distribution and underscore the need for alterations in policy to allow for equitable distribution.
journal_name
J Am Coll Surgjournal_title
Journal of the American College of Surgeonsauthors
Kohn R,Kratz JR,Markmann JF,Vagefi PAdoi
10.1016/j.jamcollsurg.2013.12.056subject
Has Abstractpub_date
2014-06-01 00:00:00pages
1113-8issue
6eissn
1072-7515issn
1879-1190pii
S1072-7515(14)00177-Xjournal_volume
218pub_type
杂志文章abstract:BACKGROUND:Closed-suction drains, implants, and acellular dermal matrix (ADM) are routinely used in tissue expander-based immediate breast reconstruction (TE-IBR). Each of these factors is thought to increase the potential for surgical site infection (SSI). Although CDC guidelines recommend only 24 hours of antibiotic ...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章,随机对照试验
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更新日期:2016-06-01 00:00:00
abstract:BACKGROUND:We sought to identify variables associated with American Board of Medical Specialties (ABMS)-member board certification and lack thereof among US medical graduates who planned at medical school graduation to become certified in surgery and entered graduate medical education in general surgery. STUDY DESIGN:...
journal_title:Journal of the American College of Surgeons
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doi:10.1016/j.jamcollsurg.2012.01.049
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journal_title:Journal of the American College of Surgeons
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journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章,多中心研究,随机对照试验
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更新日期:2016-04-01 00:00:00
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journal_title:Journal of the American College of Surgeons
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journal_title:Journal of the American College of Surgeons
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doi:10.1016/s1072-7515(02)01136-5
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journal_title:Journal of the American College of Surgeons
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abstract:BACKGROUND:Drainage methods for the gastric conduit after esophagectomy for carcinoma have been controversial. STUDY DESIGN:In a randomized controlled trial, 92 patients with esophageal carcinoma were randomized to have pyloroplasty or pyloromyotomy as a drainage procedure for the gastric conduit used for esophageal r...
journal_title:Journal of the American College of Surgeons
pub_type: 临床试验,杂志文章,随机对照试验
doi:
更新日期:1997-06-01 00:00:00
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journal_title:Journal of the American College of Surgeons
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journal_title:Journal of the American College of Surgeons
pub_type: 临床试验,杂志文章
doi:
更新日期:1995-02-01 00:00:00
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journal_title:Journal of the American College of Surgeons
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更新日期:2011-07-01 00:00:00
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journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:
更新日期:1995-03-01 00:00:00
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journal_title:Journal of the American College of Surgeons
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journal_title:Journal of the American College of Surgeons
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doi:
更新日期:1996-03-01 00:00:00
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journal_title:Journal of the American College of Surgeons
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doi:
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journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:
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journal_title:Journal of the American College of Surgeons
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journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
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pub_type: 杂志文章,多中心研究
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