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Socioeconomic status affected post-liver transplant survival rates

The post-liver transplantation survival rate was better in recipients with a higher socioeconomic status vs. those with a lower socioeconomic status, according to study data.

“This study is important because we need to identify what resources these patients need for success after liver transplant since it is such a scarce commodity with the organ shortage,” researcher Shimul A. Shah, MD, MHCM, director of liver transplantation and hepatobiliary surgery at the University of Cincinnati, told Healio.com/Hepatology. “How can transplant centers, providers and even the community help these patients with the issues they may face, either as they enter the system or when they leave?”

Shimul A. Shah

In a retrospective study, Shah and colleagues analyzed data of 12,445 patients who underwent liver transplantation between 2007 and 2011 gathered from the Scientific Registry of Transplant Recipients and University HealthSystem Consortium databases. Various analyses were used to determine any effect of socioeconomic status on survival, after adjusting and controlling characteristics of donors, recipients and the type of center where the transplantation was performed.

More liver transplant recipients in the highest socioeconomic status quintile (Q5) were male compared with recipients in the lowest socioeconomic status quintile (Q1; 70.4% vs. 63.8%), as well as more likely to be white (76.2% vs. 60%), have private insurance (69.4% vs. 49.7%) and undergo transplantation with a lower MELD score (55.6% vs. 50%). Additionally, patients in Q5 were healthier compared with Q1 patients (53.8% vs. 43.1%) and had no physical limitations (59.1% vs. 49.6%). Patients in Q1 had a greater risk for death within a median of 2 years after transplantation (HR=1.17; 95% CI, 1.02-1.35).

Recipients in Q5 were more likely to receive their transplant faster than Q1 recipients (39.9% vs. 30.9%), and recipients in the middle socioeconomic status quintile (Q3 and Q4) were more likely to have better transplantation centers compared with the Q1 recipients (63.4% and 53.8% vs. 48%).  

Transplantation center quality and volume, donor organ quality and being in the socioeconomic status Q1 were some of the independent predictors of patient survival.  

“Recipients of low [socioeconomic status] have decreased access to liver transplantation,” Shah said. “They undergo transplant when they are sicker and they go to lower volume and lower quality centers for their care compared to patients of high [socioeconomic status]. Low [socioeconomic status] patients do worse after liver transplant independent of donor, recipient, center and geographic factors.

“We can’t quite explain why the long-term outcome is worse in these patients, since they seem to do just as well after their transplant when they leave the hospital — is it a culture, neighborhood or financial issue — we are conducting further research on our own patients here in Cincinnati to try to understand that issue.” – by Melinda Stevens

Disclosure: The researchers report no relevant financial disclosures.