Novel linkage of UNOS and PHIS to assess the impact of race and socioeconomic status on pediatric liver transplant outcomes

Abstract

Background: Despite the technological advancements made in pediatric liver transplant, concerns remain about the equality of patient care during the peri-operative period. Analyses have consistently shown discrepancies in mortality, graft failure, and waitlist time across race, ethnicity and socioeconomic status. National analyses, however, are lacking as most reported data comes from single-hospital studies without adequate power to account for possible confounding variables. The aim of this study was to evaluate the impact of race, ethnicity, and SES on transplant outcomes and resource utilization on a national level, using a linked administrative database. Methods: Utilizing a novel linkage of the Scientific Registry of Transplant Recipients and the Pediatric Health Information System administrative databases, we performed a multicenter, retrospective analysis of 3609children age 18 years, who received a LT in the US between 2003 and 2017. Proportional hazards models were used to assess effect of race and SES on patient and graft survival. Resource utilization was measured by length of stay (LOS), intensive care unit (ICU) LOS, length of mechanical ventilation (MV) and vasopressors, and total charges.Results: White recipients had graft survival advantages compared to black patients (p= .007). This difference persisted after adjusting for resource utilization and recipient and donor characteristics (hazard ratio [HR]1.47; 95% CI 1.082.00). There was no significant difference in overall survival between races. Resource utilization did not differ significantly between black and white races. Privately insured recipients had advantages in both graft (p = .003) and patient survival(p = .014)compared to publicly insured patients. This difference remained when 3adjusted with the multivariate model(graft failure: HR = 1.28, 95% CI 1.011.62; survival: HR 1.38 (95% CI, 1.071.77). Publicly insured patients also had increased resource utilization compared to privately insured patients: LOS (16vs 15days, p= .001), ICU LOS (4 vs. 3 days, p=.001),TPN time(2vs. 1days, p = .004) ), and total charge ($145871vs. $129872, p< .001).Conclusions: In pediatric LT recipients, publicly insured patients showed increased risk of graft failure, death, and resource utilization as compared to privately insured patients; these differences were not as consistent across patient race, but still showed trends towards worse survival and graft failure with minority status.

Files

Additional details