Pediatr Transplant. 2024 Dec;28(8):e14881. doi: 10.1111/petr.14881.
ABSTRACT
BACKGROUND: The impact of social determinants of health (SDOH) on pediatric liver transplant outcomes has not been extensively investigated. The purpose of this study was to examine the effect of neighborhood-level deprivation on graft and patient survival among pediatric liver transplant recipients.
METHODS: This is a single-center observational study among children who received a primary liver transplant from March 1996 to March 2023. The Childhood Opportunity Index (COI) score was used to measure the degree of neighborhood deprivation.
RESULTS: A total of 252 children were included, half (52.8%) were female and the majority were non-Hispanic White (71%). Half (53.6%) of the children had private insurance, and the median COI score was 64. A total of 28 children were transplanted from a very low-to-low COI area. Children in very low-to-low COI areas had worse patient (HR = 4.90, 95% CI = 1.41-17.04, p = 0.01) and graft (HR = 3.41, 95% CI = 1.19-9.75, p = 0.02) survival outcomes compared to children in moderate-to-very high areas when adjusting for clinical characteristics. COI score remained a significant predictor of graft survival after adjusting for race and insurance type (HR = 3.41, 95% CI = 1.12-10.40, p = 0.03).
CONCLUSIONS: Pediatric liver transplant recipients from very low-to-low COI score areas have worse graft outcomes when accounting for clinical factors, race/ethnicity, and insurance status. Future research should investigate the impact of multiple, intersecting SDOH factors, rather than solely a collection of isolated variables.
PMID:39475325 | DOI:10.1111/petr.14881
