Wadhwani Sharad I, Squires James E, Hsu Evelyn, Gupta Nitika, Campbell Kathleen, Zielsdorf Shannon, Vittorio Jennifer, Desai Dev M, Ebel Noelle H, Shui Amy M, Bucuvalas John C, Gottlieb Laura M, Lyles Courtney R, Lai Jennifer C
Department of Pediatrics, University of California, San Francisco, San Francisco, California, USA.
Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA.
Liver Transpl. 2024 Dec 16. doi: 10.1097/LVT.0000000000000554.
Pediatric liver transplant outcomes exhibit disparities, necessitating the identification of modifiable risk factors to develop targeted interventions. We characterized associations between household material economic hardship (eg, financial barriers to housing or food) and pediatric liver transplant outcomes. We recruited pediatric recipients of liver transplants <18 years at the time of transplant across 8 US centers. Our primary exposure was ≥1 household material economic hardship (ie, food insecurity, housing instability, transportation challenges, or utility concerns), measured using the Accountable Healthcare Communities screening tool. Outcomes included 90-day and 1-year (1) total inpatient bed-days, and (2) episodes of T-cell-mediated rejection. Of the 77 participants (36% female), 34% reported household material economic hardship. Such hardship was associated with increased total inpatient bed-days within 90 days (ratio estimate: 1.45, 95% CI: 1.08, 1.96); the association persisted after adjusting for health literacy, insurance, and transplant center (ratio estimate: 1.37, 95% CI: 1.02, 1.84). Household material economic hardship was associated with total inpatient bed-days within 1 year after transplant (ratio estimate: 3.2, 95% CI: 1.1, 10.1); associations diminished in multivariable analyses (ratio estimate: 2.2, 95% CI: 0.7, 6.9). Household material economic hardship was associated with increased risk of T-cell-mediated rejection within 1 year of transplant (relative risk: 2.1, 95% CI: 1.1, 4.2); the association diminished in propensity-score matched analyses (relative risk: 1.4, 95% CI: 0.9, 2.3). Our findings highlight the adverse influence of household material economic hardship on pediatric liver transplant outcomes within the first year. Targeted social risk assistance and adjustment strategies offer actionable avenues to mitigate these challenges and enhance outcomes in pediatric recipients of liver transplants.
小儿肝移植的结果存在差异，因此有必要确定可改变的风险因素，以制定有针对性的干预措施。我们对家庭物质经济困难（如住房或食品的经济障碍）与小儿肝移植结果之间的关联进行了特征描述。我们招募了美国8个中心18岁以下的小儿肝移植受者。我们的主要暴露因素是≥1项家庭物质经济困难（即粮食不安全、住房不稳定、交通困难或水电问题），使用可问责医疗社区筛查工具进行测量。结果包括90天和1年的（1）总住院天数，以及（2）T细胞介导的排斥反应发作次数。在77名参与者中（36%为女性），34%报告有家庭物质经济困难。这种困难与90天内总住院天数增加有关（比值估计：1.45，95%置信区间：1.08，1.96）；在对健康素养、保险和移植中心进行调整后，这种关联仍然存在（比值估计：1.37，95%置信区间：1.02，1.84）。家庭物质经济困难与移植后1年内的总住院天数有关（比值估计：3.2，95%置信区间：1.1，10.1）；在多变量分析中，这种关联减弱（比值估计：2.2，95%置信区间：0.7，6.9）。家庭物质经济困难与移植后1年内T细胞介导的排斥反应风险增加有关（相对风险：2.1，95%置信区间：1.1，4.2）；在倾向评分匹配分析中，这种关联减弱（相对风险：1.4，95%置信区间：0.9，2.3）。我们的研究结果突出了家庭物质经济困难对小儿肝移植第一年结果的不利影响。有针对性的社会风险援助和调整策略提供了可行的途径，以减轻这些挑战，并改善小儿肝移植受者的结果。
