De Simone, P.; Bronzoni, J.; Lai, Q.; Martinelli, C.; Ducci, J.; Campani, D.; Gitto, S.; Marchetti, P. Socioeconomic Deprivation Is Associated with Worse Outcomes after Adult Liver Transplantation. Preprints2024, 2024011795. https://doi.org/10.20944/preprints202401.1795.v1
APA Style
De Simone, P., Bronzoni, J., Lai, Q., Martinelli, C., Ducci, J., Campani, D., Gitto, S., & Marchetti, P. (2024). Socioeconomic Deprivation Is Associated with Worse Outcomes after Adult Liver Transplantation. Preprints. https://doi.org/10.20944/preprints202401.1795.v1
Chicago/Turabian Style
De Simone, P., Stefano Gitto and Piero Marchetti. 2024 "Socioeconomic Deprivation Is Associated with Worse Outcomes after Adult Liver Transplantation" Preprints. https://doi.org/10.20944/preprints202401.1795.v1
Abstract
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.
Copyright:
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
,
,
,
,
,
,
,
