The impact of race and socioeconomical status on the conditional graft and patient survival after 5-year in liver transplantation

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Background: Race and socioeconomic status have been reported to aff ect graft survival in adult liver transplant recipients, but there are few reports on the eff ects on long-term survivors.We hypothesized that impact of socioeconomic status on patient outcomes might persist even in very long-term.In this study, we assessed possible impact of race and socioeconomic status on their very-long term outcomes.Method: Adult liver transplant alone performed from 2003-2013 were evaluated to compare 10-year survivals using the United Network for Organ Sharing database.To minimize prognostic impacts of early post-transplant complications, the conditional survival was evaluated which was defi ned as the probability of survival after 5 years in those who survived for the fi rst 5 years.(10-year survivals in 5 years survivors) Socioeconomic factors included patient education level and employment status at transplant.The impact of race and socioeconomical factors on 10-year conditional graft/patient survival in 5 years survivors was evaluated by Cox proportional hazard model.Result: In total, 71,679 adult LT were performed from 2003-2013, of which 46,659 recipients survived at 5 years post-transplant.In this population, Kaplan-Meier analysis showed that Hispanic and Asian had better 10-year conditional graft survival as compared with Black and White (p<0.01) in 5 years survivors.(Figure1) Multivariable Cox hazard model revealed that Hispanic, Asian (reference; white), and employment status at transplant improved 10-year conditional graft survival, independent of age, gender, diabetes mellitus, and MELD score.The lower education level (high school or lower, reference; postcollege graduate degree) was independently associated with worse 10-year conditional graft survival.(HR1.26,95%CI 1.11-1.42,p<0.01,HR1.14, 95%CI 1.01-1.30,p<0.01)Similarly, in multivariable Cox hazard model for 10-year conditional patient survival, Hispanic, Asian, and employment status at transplant were related to better 10-year conditional patient survival.The lower education level increased the risk of 10-year mortality.(HR1.33,95%CI 1.18-1.51,p<0.01,HR1.19, 95%CI 1.05-1.35,p=0.01)Conclusion: In liver transplantations, race and socioeconomic status signifi cantly impacted very long-term outcomes, even after minimizing prognostic impacts of early post-transplant complications.

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