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Lower socioeconomic status increased mortality risk after LT

Liver transplant recipients of lower socioeconomic status were more likely to face mortality after transplantation, compared with recipients from a higher socioeconomic status, according to new study findings.

Researchers assessed data from the University HealthSystem Consortium and Scientific Registry of Transplant Recipients databases for 12,445 patients who underwent liver transplantation between 2007 and 2011 to determine whether socioeconomic status (SES) affected post-transplant outcomes.

Data indicated that recipients in the highest SES quintile (Q5) underwent transplantation with a lower MELD score, were older men (aged older than 60 years), Caucasian and had private insurance, compared with recipients in the lowest SES quintile (Q1). Patients in Q5 were healthier with independent functional status (53.8% vs. 43.1%) and had no physical limitations (59.1% vs. 49.6%) at time of transplantation, compared with Q1.

Recipients in Q1 had an increased risk for mortality within a median of 2 years after transplantation (HR=1.17; 95% CI, 1.02-1.35). SES Q5 recipients received higher risk organs, compared with SES Q1 (24.9% vs. 19.3%) and SES Q3 (22.7%). SES Q5 recipients were likelier to receive their transplant at a high volume (39.9% vs. 30.9%) and higher quality center (Q3-Q4: 63.4% vs. 48%), compared with SES Q1. No differences were observed in length of stay, in-hospital mortality and 30-day readmission among the high and low SES groups.

“Barriers to orthotopic liver transplantation (OLT) may exist for patients living in neighborhoods of low SES,” the researchers wrote. “These patients also demonstrate a significantly worse survival after OLT independent of recipient, donor, center or geographic effects. Further research is needed to address these disparities and determine if it is indeed an issue of access to OLT, a wait list problem or finally, a selection issue at time of OLT.”

Disclosure: The researchers report no relevant financial disclosures.