Association of Neighborhood Deprivation and Transplant Center Quality with Liver Transplantation Outcomes

Abstract

Background: Social determinants of health (SDoH) can impact the quality of liver transplantation (LT) care. We sought to assess whether the association between neighborhood deprivation and transplant outcomes can be mitigated by receiving care at high-quality transplant centers. Study Design: Population-based cohort study on patients who underwent LT between 2004-2019 were identified in the Scientific Registry of Transplant Recipients. LT-recipient neighborhoods were identified at the county level and stratified into quintiles relative to Area Deprivation Index (ADI). Transplant center quality was based on the SRTR 5-tier ranking using standardized transplant rate-ratios. Multivariable Cox regression was used to assess the relationship between ADI, hospital quality and posttransplant survival. Results: A total of 41,333 recipients (median age, 57.0 [50.0-63.0] years; 27,112 [65.4%] male) met inclusion criteria. Patients residing in the most deprived areas were more likely to have NASH, be Black, and travel further distances to reach a transplant center. On multivariable analysis, post-LT long-term mortality was associated with low- vs high-quality transplant centers (HR, 1.19; 95%CI, 1.07-1.32), as well as among patients residing in high vs low ADI neighborhoods (HR, 1.25; 95%CI, 1.16-1.34) (both P≤0.001). Of note, individuals residing in high vs low ADI neighborhoods had a higher risk of long-term mortality after treatment at a low-quality (HR 1.31; 95%CI, 1.06–1.62, P=0.011) vs high-quality (HR, 1.12; 95%CI, 0.83–1.52, P=0.471) LT center. Conclusion: LT at high-quality centers may be able to mitigate the association between posttransplant survival and neighborhood deprivation. Investments and initiatives that increase access to referrals to high-quality centers for patients residing in higher deprivation may lead to better outcomes and help mitigate disparities in liver transplantation.