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Published on: August 17, 2022
Do funding sources influence long-term patient survival in pediatric liver transplantation?
André A S Dick1,2, Elizabeth Winstanley3, Michael Ohara3
1Division of Transplantation, Department of Surgery, University of Washington, Seattle, WA, USA.
Insights
Pediatric liver transplant recipients with Medicaid insurance face significantly higher risks of death. This highlights a need for enhanced post-transplant support for these vulnerable children to improve long-term survival outcomes.
Area of Science:
- Pediatric Surgery
- Transplantation Immunology
- Health Services Research
Background:
- Socioeconomic status (SES) is linked to poorer outcomes in various surgeries.
- Limited research exists on SES impact in pediatric liver transplantation.
- Insurance status serves as a proxy for SES in this study.
Purpose of the Study:
- To assess the effect of insurance status on patient and allograft survival.
- To investigate the association between socioeconomic factors and pediatric liver transplant outcomes.
Main Methods:
- Retrospective analysis of 6997 pediatric first-time liver transplant recipients (2002-2017).
- Utilized UNOS database and mixed Cox proportional hazards model.
- Adjusted for donor, recipient, and program characteristics.
Main Results:
- Medicaid insurance significantly negatively impacted long-term survival.
- Patients with Medicaid had a 1.42 increased risk of post-transplant death (CI: 1.18-1.60).
Conclusions:
- Medicaid insurance is a significant risk factor for mortality in pediatric liver transplant recipients.
- These patients may require comprehensive post-transplant support to enhance survival.
- Addressing socioeconomic disparities is crucial for improving outcomes in pediatric liver transplantation.
Background:
Socioeconomic status has been associated with inferior outcomes after multiple surgical procedures, but has not been well studied with respect to pediatric liver transplantation. This study evaluated the impact of insurance status (as a proxy for socioeconomic status) on patient and allograft survival in pediatric first-time liver transplant recipients.
Methods:
Our retrospective analysis of the UNOS data base from January 2002 through September 2017 revealed 6997 pediatric patients undergoing first-time isolated liver transplantation. A mixed Cox proportional hazards model adjusted for donor, recipient, and program characteristics determined the RR of insurance status on allograft and patient survival. All results were considered significant at P < .05. All statistical results were obtained using R version 3.5.1 and coxme version 2.2-10.
Results:
Medicaid status had a significant negative impact on long-term survival after controlling for multiple covariates. Pediatric patients undergoing first-time isolated liver transplantation with Medicaid insurance had a RR of 1.42 [confidence interval: 1.18-1.60] of post-transplant death.
Conclusion:
Pediatric patients undergoing first-time isolated liver transplantation have multiple risk factors that may impact long-term survival. Having Medicaid insurance almost doubles the chances of dying post-liver transplant. This patient population may require more global support post-transplant to improve long-term survival.
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