Neighborhood socioeconomic deprivation is associated with worse patient and graft survival following pediatric liver transplantation

Sharad I. Wadhwani, Andrew F. Beck, John Bucuvalas, Laura Gottlieb, Uma Kotagal, Jennifer C. Lai

Research output: Contribution to journalArticlepeer-review

37 Scopus citations

Abstract

Long-term outcomes remain suboptimal following pediatric liver transplantation; only one third of children have normal biochemical liver function without immunosuppressant comorbidities 10 years posttransplant. We examined the association between an index of neighborhood socioeconomic deprivation with graft and patient survival using the Scientific Registry of Transplant Recipients. We included children <19 years who underwent liver transplantation between January 1, 2008 to December 31, 2013 (n = 2868). Primary exposure was a neighborhood socioeconomic deprivation index—linked via patient home ZIP code—with a range of 0-1 (values nearing 1 indicate neighborhoods with greater socioeconomic deprivation). Primary outcome measures were graft failure and death, censored at 10 years posttransplant. We modeled survival using Cox proportional hazards. In univariable analysis, each 0.1 increase in the deprivation index was associated with a 14.3% (95% confidence interval [CI]): 3.8%-25.8%) increased hazard of graft failure and a 12.5% (95% CI: 2.5%-23.6%) increased hazard of death. In multivariable analysis adjusted for race, each 0.1 increase in the deprivation index was associated with a 11.5% (95% CI: 1.6%-23.9%) increased hazard of graft failure and a 9.6% (95% CI: −0.04% to 20.7%) increased hazard of death. Children from high deprivation neighborhoods have diminished graft and patient survival following liver transplantation. Greater attention to neighborhood context may result in improved outcomes for children following liver transplantation.

Original languageEnglish
Pages (from-to)1597-1605
Number of pages9
JournalAmerican Journal of Transplantation
Volume20
Issue number6
DOIs
StatePublished - 1 Jun 2020

Keywords

  • Scientific Registry for Transplant Recipients (SRTR)
  • clinical research/practice
  • ethnicity/race
  • graft survival
  • health services and outcomes research
  • insurance
  • liver transplantation/hepatology
  • patient survival
  • pediatrics
  • social sciences

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