Racial and Socioeconomic Disparities in Pediatric Liver Transplant Outcomes: A Single-Center Experience Open Access

Abstract

Racial and socioeconomic (SES) disparities have been found to affect liver transplantation
outcomes in adult populations, but little research exists in pediatric liver transplant populations. The
purpose of this study is to examine the effect of race on patient outcomes of graft survival and
mortality following liver transplantation.

A retrospective cohort of pediatric patients (ages 0-22) who received a first liver transplant at
Children's Hospital of Atlanta (CHOA) between 1998 and 2008 were followed through 2011 to
capture graft failure and mortality events. Information on individual race, clinical, demographic, and
SES variables were determined from CHOA records, referrals to the Georgia Transplant
Foundation, and United Network for Organ Sharing (UNOS). Neighborhood characteristics were
derived from US Census 2000 data by patient addresses. The association between race and the
probability of graft failure and mortality was examined using Cox-Proportional Hazard models. Black
and other non-white races were combined in analyses.

Among 208 patients included in the cohort study, 51.0% were white, 34.6% black and 14.4%
other races. A total of 27 patients (13.0%) experienced graft failure and 34 (16.4%) died during the
median 8.3 years of study follow-up. In adjusted analyses, the rate of graft failure [HR 2.80, 95% CI
(1.07, 7.34)] and mortality [HR 4.11, 95% CI (1.63, 10.37)] was significantly higher among minorities
compared to whites.

After adjusting for SES and other clinical factors, minority race was associated with twice the
rate of graft failure and four times the rate of mortality compared to white patients in a pediatric liver
population. Further study of race and SES is warranted in this population.

Table of Contents

Table of Contents

Chapter I: Background/Literature Review. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1
Chapter II: Manuscript. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Title, Authors, Abstract . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6
Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8
Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
Discussion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14
Tables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18
Figures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
Chapter III: Summary, Public Health Implications, Possible Future Directions . . . . . . . . . . . . . . . . . . . . 26
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29

About this Master's Thesis

Rights statement

• Permission granted by the author to include this thesis or dissertation in this repository. All rights reserved by the author. Please contact the author for information regarding the reproduction and use of this thesis or dissertation.

School	Rollins School of Public Health
Department	Epidemiology
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Epidemiology
Keyword	Socioeconomic status Liver transplant Pediatric Race
Committee Chair / Thesis Advisor	Patzer, Rachel Elizabeth, Emory University
Partnering Agencies	Does not apply (no collaborating organization)

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