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Neighborhood Deprivation Linked to Medication Level Variability in Liver Transplant Recipients.
Laila Fozouni1, Giuseppe Cullaro2, Ann Lazar3
1Department of Medicine, University of California, San Francisco, California, USA.
Clinical Transplantation
|December 12, 2025
Summary
Neighborhood deprivation is linked to higher medication level variability and hospitalization risk after liver transplants. Further research is needed to improve immunosuppression adherence in disadvantaged populations.
Area of Science:
- Transplantation Medicine
- Social Determinants of Health
- Pharmacology
Background:
- Neighborhood deprivation is linked to poorer outcomes in pediatric liver transplant recipients.
- The impact of neighborhood deprivation on adult liver transplant recipients remains under investigation.
Purpose of the Study:
- To examine the association between neighborhood deprivation index (NDI) and medication level variability index (MLVI), T-cell mediated rejection (TCMR), and graft failure/death in adult liver transplant recipients.
Main Methods:
- Retrospective cohort study of 1485 adult liver transplant recipients with over 1 year of follow-up.
- Neighborhood deprivation index (NDI) calculated at the census tract level.
- Medication level variability index (MLVI) dichotomized at MLVI > 2; hospitalization analyzed as a binary variable.
Main Results:
- Increased NDI was associated with higher odds of MLVI > 2 (1-3 years post-transplant) and increased hospitalization risk (1-3 years post-transplant).
- NDI was not significantly associated with rejection or graft failure/death.
- MLVI > 2 was associated with higher hazard of rejection and graft failure/death, independent of NDI. Geospatial hotspots of rejection were identified.
Conclusions:
- Disadvantaged neighborhood individuals may experience poorer immunosuppression adherence.
- Targeted strategies are needed to improve medication adherence for high-risk groups post-liver transplant.
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