Association of state Medicaid expansion policies with pediatric liver transplant outcomes

Shifman, Holly Payton; Huang, Chiung-Yu; Beck, Andrew F.; Bucuvalas, John; Perito, Emily R.; Hsu, Evelyn K.; Ebel, Noelle H.; Lai, Jennifer C.; Wadhwani, Sharad I.

doi:10.1016/j.ajt.2023.09.017

Cited by 2 publications

(7 citation statements)

References 34 publications

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“…There is increasing evidence on how socio-economic factors affect outcomes in pediatric LT (9)(10)(11)(12)(13)(14)(15)(16), but information on adult recipients is limited, especially outside the US (17)(18)(19)(20)(21)(22)(23)(24)(25). To our knowledge, this is the first study from a European transplant center after the one by Menahem et al in 2021 which focused only on HCC (22).…”

Section: Discussionmentioning

confidence: 93%

“…A total of 2,568 recipients matched the inclusion criteria (Table 1). Patients were predominantly male (72.5%) of a median (interquartile (IQR)) age of 56 (10) years. The most frequent chronic liver disease was HCV-related cirrhosis (48.7%), followed by HBV (26.0%) and alcohol-related liver disease (10.9%).…”

Section: Demographics and Clinical Characteristicsmentioning

confidence: 99%

“…After controlling for individual medical variables, SED independently predicts specific poor health outcomes. This indicates that social and environmental barriers beyond the control of individual patients play a significant role in driving health outcomes (7,8) 2 LT is inequitably available, and disparities impact all its phases, from the referral of liver disease patients to long-term post-transplant care (9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24). In pediatric populations, SED is associated with delayed referral, higher waitlist mortality, and reduced access to living donor transplantation (9).…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…SED is a crucial factor to consider for the best possible outcome of pediatric and adult LT (9,10). If we can understand the extent to which deprivation characteristics are associated with posttransplant outcomes, we can identify actionable objectives for health improvement (9,10). The current study conducted a retrospective analysis to investigate the correlation between neighborhood SED and patient and graft survival in a group of adult transplant recipients who underwent surgery between 1996 and 2022.…”

Section: Introductionmentioning

confidence: 99%

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Socioeconomic Deprivation Is Associated with Worse Outcomes after Adult Liver Transplantation

De Simone,

Bronzoni,

Lai

et al. 2024

Preprint

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Background and Aims: The present study analyzed retrospectively the association between socioeconomic deprivation and graft and patient survival in a cohort of 2,568 adult recipients of a liver transplant between 1996 and 2022. Materials and methods: The primary exposure was a nationally validated socioeconomic deprivation index (DI) at census block level and ranking from 1-5, with higher ranks indicating more significant socioeconomic deprivation. Results: At a median (IQR) follow-up of 144.8 (204) months, the overall patient and graft survival rates were 92% and 90.4% at 1 year, 78.4% and 72.2% at 5 years, and 58% and 56.7% at 10 years. Recipients with a DI rank above the median (i.e., more deprived) had 1, 5, and 10-year patient and graft survival rates of 91% and 89.5%, 70.4% and 68.4%, 48% and 46.7%, respectively, versus 92% and 90.4%, 78.4% and 72.2%, and 58% and 56.7% for less deprived patients (log-rank p<0.001). More deprived patients had a higher risk of death (p<0.0001), hypertension (p<0.0001), obesity (p=0.02), diabetes mellitus (p=0.02), graft rejection (p<0.0001), chronic kidney dysfunction (p<0.0001), major cardiovascular events (p<0.0001) and de novo malignancies (p<0.0001) than less deprived recipients. The factors associated with the survival probability were younger donor and recipient ages (p=0.03 and 0.02, respectively), female recipient sex (p=0.04), absence of HCV (p<0.01), absence of HCC (p=0.02), absence of DM at transplantation (p=0.03) and 1 year (p=0.01), lower DI (p=0.02), lower MELD (0.02), shorter CIT (p=0.03), TAC (p=0.01), and EVR in the immunosuppressive regimen (p=0.02). Conclusions: Patients from more deprived areas have a higher risk of death after liver transplantation. Pre- and post-transplant socioeconomic risk profiling is warranted to better tailor care to patient’s needs and expectations.

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Section: Discussionmentioning

confidence: 93%

Section: Demographics and Clinical Characteristicsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Socioeconomic Deprivation Is Associated with Worse Outcomes after Adult Liver Transplantation

De Simone,

Bronzoni,

Lai

et al. 2024

Preprint

View full text Add to dashboard Cite

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The impact of socioeconomic deprivation on liver transplantation

De Simone,

Germani,

Lai

et al. 2024

Front. Transplant.

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Despite global expansion, social disparities impact all phases of liver transplantation, from patient referral to post-transplant care. In pediatric populations, socioeconomic deprivation is associated with delayed referral, higher waitlist mortality, and reduced access to living donor transplantation. Children from socially deprived communities are twice as much less adherent to immunosuppression and have up to a 32% increased incidence of graft failure. Similarly, adult patients from deprived areas and racial minorities have a higher risk of not initiating the transplant evaluation, lower rates of waitlisting, and a 6% higher risk of not being transplanted. Social deprivation is racially segregated, and Black recipients have an increased risk of post-transplant mortality by up to 21%. The mechanisms linking social deprivation to inferior outcomes are not entirely elucidated, and powered studies are still lacking. We offer a review of the most recent evidence linking social deprivation and post-liver transplant outcomes in pediatric and adult populations, as well as a literature-derived theoretical background model for future research on this topic.

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Association of state Medicaid expansion policies with pediatric liver transplant outcomes

Cited by 2 publications

References 34 publications

Socioeconomic Deprivation Is Associated with Worse Outcomes after Adult Liver Transplantation

Socioeconomic Deprivation Is Associated with Worse Outcomes after Adult Liver Transplantation

The impact of socioeconomic deprivation on liver transplantation

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