The impact of race and socioeconomical status on the conditional graft and patient survival after 5-year in liver transplantation

Document Type

Conference Proceeding

Publication Date

1-1-2025

Publication Title

Am J Transplant

Keywords

biological marker, adult, Asian, Caucasian, cohort analysis, conference abstract, controlled study, diabetes mellitus, employment status, female, gender, graft recipient, graft survival, high school, Hispanic, human, liver transplantation, major clinical study, male, Model For End Stage Liver Disease Score, mortality, overall survival, patient education, race, social status, socioeconomics, transplant complication, treatment outcome

Abstract

Background: Race and socioeconomic status have been reported to affect graft survival in adult liver transplant recipients, but there are few reports on the effects on long-term survivors. We hypothesized that impact of socioeconomic status on patient outcomes might persist even in very long-term. In this study, we assessed possible impact of race and socioeconomic status on their very-long term outcomes. Method: Adult liver transplant alone performed from 2003-2013 were evaluated to compare 10-year survivals using the United Network for Organ Sharing database. To minimize prognostic impacts of early post-transplant complications, the conditional survival was evaluated which was defined as the probability of survival after 5 years in those who survived for the first 5 years. (10-year survivals in 5 years survivors) Socioeconomic factors included patient education level and employment status at transplant. The impact of race and socioeconomical factors on 10-year conditional graft/patient survival in 5 years survivors was evaluated by Cox proportional hazard model. Result: In total, 71,679 adult LT were performed from 2003-2013, of which 46,659 recipients survived at 5 years post-transplant. In this population, Kaplan-Meier analysis showed that Hispanic and Asian had better 10-year conditional graft survival as compared with Black and White (p<0.01) in 5 years survivors. (Figure 1) Multivariable Cox hazard model revealed that Hispanic, Asian (reference; white), and employment status at transplant improved 10-year conditional graft survival, independent of age, gender, diabetes mellitus, and MELD score. The lower education level (high school or lower, reference; postcollege graduate degree) was independently associated with worse 10-year conditional graft survival. (HR1.26, 95%CI 1.11-1.42, p<0.01, HR1.14, 95%CI 1.01-1.30, p<0.01) Similarly, in multivariable Cox hazard model for 10-year conditional patient survival, Hispanic, Asian, and employment status at transplant were related to better 10-year conditional patient survival. The lower education level increased the risk of 10-year mortality. (HR1.33, 95%CI 1.18-1.51, p<0.01, HR1.19, 95%CI 1.05-1.35, p=0.01) Conclusion: In liver transplantations, race and socioeconomic status significantly impacted very long-term outcomes, even after minimizing prognostic impacts of early post-transplant complications. [Formula presented] DISCLOSURES: A. Nishimagi: None. R. Oki: None. I. Rocha: None. S. Al- Juburi: None. L. Rajendran: None. E. Kerby: None. A. Mohamed: None. A. Nassar: None. A. Al-Kurd: None. A. Yoshida: None. M. Abouljoud: None. S. Nagai: None.

Volume

25

Issue

1

First Page

S124

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