A retrospective cohort study of socioeconomic deprivation and post-liver transplant survival in adults

Area Deprivation Index is a granular measure of neighborhood socioeconomic deprivation. The relationship between neighborhood socioeconomic deprivation and recipient survival following liver transplantation is unclear. To investigate this, we performed a retrospective cohort study of adults who underwent liver transplantation at the University of Washington Medical Center from January 1, 2004 to December 31, 2020. The primary exposure was degree of neighborhood socioeconomic deprivation as determined by Area Deprivation Index score. The primary outcome was post- transplant recipient mortality. In a multivariable Cox proportional analysis, liver transplant recipients from high deprivation areas had a higher risk of mortality than those from low deprivation areas (hazard ratio: 1.81; 95% CI: 1.03-3.18, p=0.04). Notably, the difference in mortality between area deprivation groups did not become statistically significant until 6 years after transplantation. In summary, liver transplant recipients experiencing high socioeconomic deprivation tended to have worse post-transplant survival. Further research is needed to elucidate the extent to which neighborhood socioeconomic deprivation contributes to mortality risk and identify effective measures to improve survival in more socioeconomically disadvantaged liver transplant recipients.