Adverse family social circumstances and outcome in pediatric cardiac transplant recipients at a UK center.
BACKGROUND
Socioeconomic disadvantage is known to prejudice certain health-related outcomes.


METHODS
Our objective was to establish whether adverse social circumstances are linked to rejection events after pediatric cardiac transplant in a UK context. A retrospective observational cohort study was conducted including 78 of 85 children who underwent cardiac transplantation between 2001 and 2005.


RESULTS
Family social circumstances included: 36 (46%) unemployed/manual occupation; 29 (37%) non-home owners; 16 (21%) single parents; income support in 31 (40%); and 2 or more further children in 34 (44%). Adverse social risk factors were evenly distributed throughout the cohort in terms of other demographic variables. The rate for a first rejection event was 0.10 (95% confidence interval [CI] 0.07 to 0.15) episode per patient per year, and for late rejection was 0.04 (95% CI 0.02 to 0.07) episode per patient per year. There was some evidence that children from non-home-owning families (hazard ratio [HR] 0.31, 95% CI 0.11 to 0.82, p = 0.02) and those on income support (HR 0.43, 95% CI 0.18 to 1.04, p = 0.06) had reduced risk of early/all first-time rejection episodes. Other social risk factors were unrelated to early rejection. No relationship was found between any social factor and late rejection episodes or low immunosuppression levels at clinic visits 3, 6 or 12 months post-transplant.


CONCLUSIONS
Children from more adverse circumstances were not predisposed to rejection episodes. To date, there is no evidence to support a policy of declining children for transplantation on psychosocial grounds in the UK.
Cardiac Unit, Great Ormond Street Hospital, London, UK. brownk@gosh.nhs.uk
Kate L
KL
Brown
Raghu
R
Ramaiah
Matthew
M
Fenton
Tracey Lunnon
TL
Wood
Katherine
K
Scott
Kate
K
Carter
Jo
J
Wray
Michael
M
Burch
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005190:Family / Q000523:psychology*; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology* / Q000209:etiology; D016027:Heart Transplantation; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D012307:Risk Factors; D012923:Social Class; D012959:Socioeconomic Factors; D015996:Survival Rate / Q000639:trends; D006113:United Kingdom / Q000453:epidemiology