本文由小咖机器人翻译整理

期刊来源：JAMA

原文链接：https://doi.org/10.1001/jama.2024.0065

摘要内容如下：

重要性

上市前必须克服心脏移植的障碍。目前还不清楚为什么黑人男性和女性在上市后接受心脏移植的可能性仍然低于白人男性和女性。

目的

评估心脏移植候选人（即移植等待名单上的患者）的种族或性别是否与移植中心团队每次接受供体心脏的概率相关。

设计、设置和参与者

这项队列研究使用器官共享联合网络（United Network for Organ Sharing）数据集来确定2018年10月18日至2023年3月31日期间美国非西班牙裔黑人（以下简称“黑人”）和非西班牙裔白人（以下简称“白人”）成人接受心脏移植的器官接受度。

曝光

心脏移植候选人的黑人或白人种族和性别（男性，女性）。

主要成果和措施

主要结果是移植中心团队接受了心脏提议。使用离散时间-事件分析、非参数分析（按种族和性别分层）和参数分析来评估接受提议的数量。使用广义线性混合模型对每个要约的要约接受风险概率进行建模，并对候选人、捐赠者和要约水平变量进行调整。

结果

在159177名心脏捐赠者和13760名捐赠者中，有14890名候选人被列入心脏移植名单。黑人占30.9%，白人占69.1%，男性占73.6%，女性占26.4%。白人女性接受提议的累积发生率最高，其次是黑人女性、白人男性和黑人男性（P<.001）。黑人候选人第一次被录取的几率低于白人候选人（优势比[OR]，0.76；95%置信区间，0.69-0.84），直至第16次报价。女性第一次接受邀请的几率比男性高（OR，1.53；95%CI，1.39-1.68），第10次至第31次报价较低。

结论和相关性

移植中心团队接受心脏提议的累积发生率，黑人候选人始终低于同性别的白人候选人，而女性则高于男性。在对候选人、捐赠者和报价水平变量进行调整后，这些差异仍然存在，这可能表明决策过程中存在种族和性别偏见。对现场决策的进一步研究可能会揭示公平接受供体心脏的策略。

英文原文如下：

Abstracts

Importance  Barriers to heart transplant must be overcome prior to listing. It is unclear why Black men and women remain less likely to receive a heart transplant after listing than White men and women.

Objective  To evaluate whether race or gender of a heart transplant candidate (ie, patient on the transplant waiting list) is associated with the probability of a donor heart being accepted by the transplant center team with each offer.

Design, Setting, and Participants  This cohort study used the United Network for Organ Sharing datasets to identify organ acceptance with each offer for US non-Hispanic Black (hereafter, Black) and non-Hispanic White (hereafter, White) adults listed for heart transplant from October 18, 2018, through March 31, 2023.

Exposures  Black or White race and gender (men, women) of a heart transplant candidate.

Main Outcomes and Measures  The main outcome was heart offer acceptance by the transplant center team. The number of offers to acceptance was assessed using discrete time-to-event analyses, nonparametrically (stratified by race and gender) and parametrically. The hazard probability of offer acceptance for each offer was modeled using generalized linear mixed models adjusted for candidate-, donor-, and offer-level variables.

Results  Among 159 177 heart offers with 13 760 donors, there were 14 890 candidates listed for heart transplant; 30.9% were Black, 69.1% were White, 73.6% were men, and 26.4% were women. The cumulative incidence of offer acceptance was highest for White women followed by Black women, White men, and Black men (P < .001). Odds of acceptance were less for Black candidates than for White candidates for the first offer (odds ratio [OR], 0.76; 95% CI, 0.69-0.84) through the 16th offer. Odds of acceptance were higher for women than for men for the first offer (OR, 1.53; 95% CI, 1.39-1.68) through the sixth offer and were lower for the 10th through 31st offers.

Conclusions and Relevance  The cumulative incidence of heart offer acceptance by a transplant center team was consistently lower for Black candidates than for White candidates of the same gender and higher for women than for men. These disparities persisted after adjusting for candidate-, donor-, and offer-level variables, possibly suggesting racial and gender bias in the decision-making process. Further investigation of site-level decision-making may reveal strategies for equitable donor heart acceptance.

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