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

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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