Influence of socioeconomic factors on liver transplant survival outcomes in patients with autoimmune liver disease in the United States

Abstract

Introduction and Objectives: Autoimmune liver diseases (AILDs): autoimmune hepatitis (AIH), primary biliary cholangitis (PBC), and primary sclerosing cholangitis (PSC) have different survival outcomes after liver transplant (LT). Outcomes are influenced by factors including disease burden, medical comorbidities, and socioeconomic variables. Materials and Methods: Using the United Network for Organ Sharing database (UNOS), we identified 13,702 patients with AILDs listed for LT between 2002 and 2021. Outcomes of interest were waitlist removal, post-LT patient survival, and post- LT graft survival. A stepwise multivariate analysis was performed adjusting for transplant recipient gender, race, diabetes mellitus, model for end-stage liver disease (MELD) score, and additional social determinants including the presence of education, reliance on public insurance, working for income, and U.S. citizenship status. Results: Lack of college education and having public insurance increased the risk of waitlist removal (HR, 1.13; 95 % CI, 1.05–1.23, and HR, 1.09; 95 % CI, 1.00–1.18; respectively), and negatively influenced post-LT patient survival (HR, 1.16; 95 % CI, 1.06–1.26, and HR, 1.15; 95 % CI, 1.06–1.25; respectively) and graft survival (HR, 1.13; 95 % CI, 1.05–1.23, and HR, 1.15; 95 % CI, 1.06–1.25; respectively). Not working for income proved to have the greatest detrimental impact on both patient survival (HR, 1.41; 95 % CI, 1.24–1.6) and graft survival (HR, 1.21; 95 % CI, 1.09–1.35). Conclusions: Our study highlights that lack of college education and public insurance have a detrimental impact on waitlist mortality, patient survival, and graft survival. Not working for income negatively affects post-LT survival outcomes. Not having U.S. citizenship does not affect survival outcomes in AILDs patients.