Neighborhood Deprivation Predicts Poorer Liver Transplant Outcomes in Children

Illustration of a girls liver.
A team of researchers sought to determine whether neighborhood deprivation affected outcomes in pediatric patients having undergone hepatic transplantation.

Socioeconomic deprivation was found to be associated with poorer outcomes after liver transplantation in pediatric patients, according to study data presented at The Liver Meeting Digital Experience, held online from November 13 to 16, 2020. However, high-performing transplantation centers were associated with better long-term outcomes, regardless of socioeconomic strata.

Investigators extracted data from the Scientific Registry of Transplant Recipients (SRTR) for the years 2008 through 2013. All liver transplant recipients younger than 18 years were eligible for inclusion. Patients were matched to a validated socioeconomic deprivation index by using their home ZIP code. The primary exposure of interest was the median patient deprivation index of the transplant center. Centers were determined to have “low” or “high” patient deprivation based on median deprivation index. Centers were also characterized as “high” or “low” performing based on 10-year graft survival rates among their patients. The primary outcome was 10-year graft survival among pediatric transplant recipients. Cox regression models were used to characterize the relationship between patient deprivation and graft loss. Models were adjusted for various center-level characteristics, including the proportion of patients with more advanced liver disease and most common liver disease etiologies.

Data were available for 2474 pediatric liver transplant recipients. The mean socioeconomic deprivation index was 0.38 ± 0.12, which is comparable to that of the US population (0.36 ± 0.11). Ten-year graft survival was 78%. In univariable regression models, each 0.1-unit increase in center deprivation was associated with increased risk of graft loss (hazard ratio [HR], 1.28; 95% CI, 0.99-1.65). In adjusted models, center deprivation remained significantly associated with graft loss (HR, 1.32; 95% CI, 1.05-1.66). However, when analyses were stratified by center performance status, the effect of center deprivation was no longer significant (HR 1.07, 95% CI, 0.89-1.28).

Per these analyses, neighborhood socioeconomic status has a significant impact on long-term graft survival in pediatric liver transplant recipients. However, center-specific performance was able to minimize the effect of socioeconomic deprivation. “Future work should characterize center-level practices that contribute to more equitable outcomes for children,” the investigators wrote.  

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Wadhwani S, Huang C-Y, Gottlieb L, et al. 0151 – Center-level variation in long-term outcomes for children undergoing liver transplantation—does a child’s home neighborhood matter? Presented at: The Liver Meeting Digital Experience; November 13-16, 2020. P20330.