The impact of Area Deprivation Index on the conditional post-liver transplant patient survival after 5-year
Recommended Citation
Nishimagi A, Oki R, Suzuki T, Avedikian J, Rajendran L, Mohamed A, Nassar A, Al-Kurd A, Yoshida A, Abouljoud M, Nagai S. The impact of Area Deprivation Index on the conditional post-liver transplant patient survival after 5-year. Am J Transplant 2026; 26(1).
Document Type
Conference Proceeding
Publication Date
1-15-2026
Publication Title
Am J Transplant
Abstract
Background: It has been reported that Area Deprivation Index (ADI) was associated with patient survival in adult liver transplant (LT) recipients, but there are few reports investigating its associations with very long-term outcomes. The aim of this study was to investigate the effect of ADI on very long-term outcomes in LT recipients. Methods: Adult LT alone performed from 2000-2013 were evaluated to compare 10-year survivals in 5-year survivors using the United Network for Organ Sharing database. To minimize impacts of early post-transplant medical and/or surgical complications, the conditional survival was evaluated which was defined as the probability of survival at 10 years in those who survived for the first 5 years(10-year conditional survivals in 5-year survivors). ADI, ranging from 1 to 100 and derived from 9-digit ZIP codes in the Neighborhood Atlas, was assigned using the median value of the corresponding 5-digit ZIP code. Patients were classified into quartiles (Q1: 1-26, Q2: 27-49, Q3: 50-71, Q4: 72-100). The impact of ADI on 10-year conditional patient survival in 5-year survivors was evaluated by Cox proportional hazard model. Result: In total, 71,679 adult LT were performed, with 54,139 transplant recipients surviving five years post-transplant from 2000 to 2013. Among these 5-year survivors, we analyzed 37,746 patients of whom data for ZIP code and ADI at the time of transplantation were available. Kaplan-Meier analysis showed significant differences in 10-year conditional patient survival across ADI quartiles, with Q1 showing the highest survival rate and Q4 the lowest (p < 0.001)(Fig.1). Cox hazard model for 10-year conditional patient survival revealed that higher ADI quartiles compared with Q1 were significantly associated with worse long-term survival (Q2: HR 1.12, 95% CI 1.04-1.21, p = 0.004, Q3: HR 1.18, 95% CI 1.09-1.27, p < 0.001, Q4: HR 1.28, 95% CI 1.19-1.38, p < 0.001). In the cause-specific Cox regression analysis, Q4 compared with Q1 was associated with higher risks of cardiovascular death (csHR 1.27, 95% CI 1.00-1.61, p=0.049), graft-related death (csHR 1.50, 95% CI 1.08-2.08, p=0.015), infection (csHR 1.44, 95% CI 1.12-1.84, p=0.004), multiple organ failure(MOF) (csHR 1.58, 95% CI 1.14-2.18, p=0.006), and respiratory death (csHR 1.54, 95% CI 1.08-2.19, p=0.019). Conclusion: In LT, ADI significantly impacted very long-term outcomes, even after minimizing prognostic impacts of early post-transplant complications. In high-ADI regions, prevention against cardiovascular, infectious, respiratory, and MOF is necessary in addition to graft-related causes.
Volume
26
Issue
1
