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Background Socioeconomic status has been associated with inferior outcomes after multiple surgical procedures, but has not been well studied with respect to pediatric liver transplantation. This study evaluated the impact of insurance status (as a proxy for socioeconomic status) on patient and allograft survival in pediatric first‐time liver transplant recipients. Methods Our retrospective analysis of the UNOS data base from January 2002 through September 2017 revealed 6997 pediatric patients undergoing first‐time isolated liver transplantation. A mixed Cox proportional hazards model adjusted for donor, recipient, and program characteristics determined the RR of insurance status on allograft and patient survival. All results were considered significant at P < .05. All statistical results were obtained using R version 3.5.1 and coxme version 2.2‐10. Results Medicaid status had a significant negative impact on long‐term survival after controlling for multiple covariates. Pediatric patients undergoing first‐time isolated liver transplantation with Medicaid insurance had a RR of 1.42 [confidence interval: 1.18‐1.60] of post‐transplant death. Conclusion Pediatric patients undergoing first‐time isolated liver transplantation have multiple risk factors that may impact long‐term survival. Having Medicaid insurance almost doubles the chances of dying post‐liver transplant. This patient population may require more global support post‐transplant to improve long‐term survival.

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