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Articles by D. L Segev
Total Records ( 2 ) for D. L Segev
  A Stojadinovic , N Ahuja , S. M Nazarian , D. L Segev , L Jacobs , Y Wang , J Eberhardt and M. A. Zeiger

Objective  To review cutting-edge, novel, implemented and potential translational research and to provide a glimpse into rich, innovative, and brilliant approaches to everyday surgical problems.

Data Sources  Scientific literature and unpublished results.

Study Selection  Articles reviewed were chosen based on innovation and application to surgical diseases.

Data Extraction  Each section was written by a surgeon familiar with cutting-edge and novel research in their field of expertise and interest.

Data Synthesis  Articles that met criteria were summarized in the manuscript.

Conclusions  Multiple avenues have been used for the discovery of improved means of diagnosis, treatment, and overall management of patients with surgical diseases. These avenues have incorporated the use of genomics, electrical impedence, statistical and mathematical modeling, and immunology.

  D. A Axelrod , N Dzebisashvili , M. A Schnitzler , P. R Salvalaggio , D. L Segev , S. E Gentry , J Tuttle Newhall and K. L. Lentine

Background and objectives: Variation in kidney transplant access across the United States may motivate relocation of patients with ability to travel to better-supplied areas.

Design, setting, participants, & measurements: We examined national transplant registry and U.S. Census data for kidney transplant candidates listed in 1999 to 2009 with a reported residential zip code (n = 203,267). Cox's regression was used to assess associations of socioeconomic status (SES), distance from residence to transplant center, and relocation to a different donation service area (DSA) with transplant access and outcomes.

Results: Patients in the highest SES quartile had increased access to transplant compared with those with lowest SES, driven strongly by 76% higher likelihood of living donor transplantation (adjusted hazard ratio [aHR] 1.76, 95% confidence interval [CI] 1.70 to 1.83). Waitlist death was reduced in high compared with low SES candidates (aHR 0.86, 95% CI 0.84 to 0.89). High SES patients also experienced lower mortality after living and deceased donor transplant. Patients living farther from the transplant center had reduced access to deceased donor transplant and increased risk of post-transplant death. Inter-DSA travel was associated with a dramatic increase in deceased donor transplant access (HR 1.94, 95% CI 1.88 to 2.00) and was predicted by high SES, white race, and longer deceased-donor allograft waiting time in initial DSA.

Conclusions: Ongoing disparities exist in kidney transplantation access and outcomes on the basis of geography and SES despite near-universal insurance coverage under Medicare. Inter-DSA travel improves access and is more common among high SES candidates.

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