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

Thammana, Rekha Vandana (2012)

Permanent URL: https://etd.library.emory.edu/concern/etds/1n79h456k?locale=zh
Published

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



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