• pediatric liver transplantation;
  • liver transplantation;
  • rurality;
  • access of care;
  • outcomes study

Park KT, Nanda P, Bensen R, Strichartz D, Esquivel C, Cox K. Effects of rural status on health outcomes in pediatric liver transplantation: A single center analysis of 388 patients. Pediatr Transplantation 2011: 15: 300–305. © 2011 John Wiley & Sons A/S.

Abstract:  Rural status of patients may impact health before and after pediatric LT. We used UI codes published by the USDA to stratify patients as urban or rural depending county residence. A total of 388 patients who had LT and who met criteria were included. Rejection, PTLD, and survival were used as primary outcome measures of post-LT health. UNOS Status 1 and PELD/MELD scores >20 were used as secondary outcome measures of poorer pre-LT health. Logistic regression models were run to determine associations. We did not find any statistically significant differences in pre- or post-LT outcomes with respect to rurality. Among rural patients, there was a general trend for decreased incidence of rejection (25.0% vs. 33.4%; OR 0.64, 95% CI 0.29–1.44), increased risk of PTLD (5.6% vs. 3.4%; OR 1.86, 95% CI 0.36–3.31), and decreased survival (OR 0.85, 95% CI 0.34–2.13) after LT. Rural patients also tended to be sicker at the time of LT than patients from urban areas, with increased proportion of Status 1 (OR 1.17, 95% CI 0.51–2.70) and PELD/MELD scores >20 (OR 1.20, 95% CI 0.59–2.45). From a single center experience, we conclude that rurality did not significantly affect health outcomes after LT, although a larger study may validate the general trends that rural patients may have decreased rejection, increased PTLD, and mortality, and be in poorer health at the time of LT.