title: Effects of rural status on health outcomes in pediatric liver transplantation: a single center analysis of 388 patients.
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.
authors: Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Stanford University Medical Center, Lucile Packard Children's Hospital, Palo Alto, CA, USA. ktpark@stanford.edu
authors: K T
authors: KT
authors: Park
authors: Pranav
authors: P
authors: Nanda
authors: Rachel
authors: R
authors: Bensen
authors: Debra
authors: D
authors: Strichartz
authors: Carlos
authors: C
authors: Esquivel
authors: Kenneth
authors: K
authors: Cox
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006297:Health Services Accessibility; D054625:Healthcare Disparities; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D017093:Liver Failure / Q000628:therapy*; D016031:Liver Transplantation / Q000379:methods*; D008297:Male; D017063:Outcome Assessment, Health Care; D010372:Pediatrics / Q000379:methods; D012189:Retrospective Studies; D019035:Rural Health Services / Q000458:organization & administration; D012424:Rural Population; D016896:Treatment Outcome