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| Natura: | Artículo Open Access |
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Wiley
2025
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| Accesso online: | https://onlinelibrary.wiley.com/doi/10.1111/ctr.70412 |
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| author | Laila Fozouni Giuseppe Cullaro Ann Lazar Jennifer C. Lai Sharad I. Wadhwani |
| author_facet | Laila Fozouni Giuseppe Cullaro Ann Lazar Jennifer C. Lai Sharad I. Wadhwani Laila Fozouni Giuseppe Cullaro Ann Lazar Jennifer C. Lai Sharad I. Wadhwani |
| collection | Wiley Open Access |
| contents | Neighborhood Deprivation Linked to Medication Level Variability in Liver Transplant Recipients Laila Fozouni Giuseppe Cullaro Ann Lazar Jennifer C. Lai Sharad I. Wadhwani Clinical Transplantation ABSTRACT Background Neighborhood deprivation is associated with adverse outcomes post‐liver transplantation in pediatric recipients. We examined the association between neighborhood deprivation index (NDI) and medication level variability index (MLVI), T‐cell mediated rejection (TCMR), and graft failure/death in adult liver transplant recipients. Methods We conducted a retrospective cohort study of 1485 adult liver‐transplant recipients with >1 year follow‐up. NDI was calculated at the census tract level. MLVI, the standard deviation of ≥3 sequential tacrolimus troughs, was dichotomized at MLVI > 2. Hospitalization was analyzed as a binary variable. Results The median age was 65, and 36% were female. In multivariate regression, increased NDI was associated with 20% increased odds of MLVI > 2 between 1–3 years post‐transplant (95% CI 1.1–1.3) but not MLVI > 2 between 3–5 years. NDI was associated with a 2.2 times higher hazard of hospitalization between 1–3 years post‐transplant (95% CI 1.1–4.4); but not between 3–5 years (HR 1.9, 95% CI 1.0–3.7). NDI was not significantly associated with increased hazard of rejection or graft failure/death. Adjusting for NDI, MLVI > 2 between 1–3 and 3–5 years was associated with a 30% higher hazard of rejection (95% CI 1.1–1.6), and between 1–3 years, a 40% increased hazard of graft failure/death (95% CI 1.2–1.5). We found geospatial hotspots of rejection with positive autocorrelation at Years 1–3 and 3–5 post‐transplant (Geary's C 0.97, p = 0.01). Conclusions Efforts to understand why individuals from disadvantaged neighborhoods experience poorer immunosuppression adherence may uncover targeted strategies to improve medication adherence for high‐risk groups. 10.1111/ctr.70412 http://onlinelibrary.wiley.com/termsAndConditions#vor |
| doi_str_mv | 10.1111/ctr.70412 |
| format | Artículo Open Access |
| id | wiley_oa_10_1111_ctr_70412 |
| institution | Wiley Open Access |
| license_str_mv | http://onlinelibrary.wiley.com/termsAndConditions#vor |
| publishDate | 2025 |
| publisher | Wiley |
| record_format | wiley_oa |
| spellingShingle | Neighborhood Deprivation Linked to Medication Level Variability in Liver Transplant Recipients Laila Fozouni Giuseppe Cullaro Ann Lazar Jennifer C. Lai Sharad I. Wadhwani Clinical Transplantation Neighborhood Deprivation Linked to Medication Level Variability in Liver Transplant Recipients Laila Fozouni Giuseppe Cullaro Ann Lazar Jennifer C. Lai Sharad I. Wadhwani Clinical Transplantation ABSTRACT Background Neighborhood deprivation is associated with adverse outcomes post‐liver transplantation in pediatric recipients. We examined the association between neighborhood deprivation index (NDI) and medication level variability index (MLVI), T‐cell mediated rejection (TCMR), and graft failure/death in adult liver transplant recipients. Methods We conducted a retrospective cohort study of 1485 adult liver‐transplant recipients with >1 year follow‐up. NDI was calculated at the census tract level. MLVI, the standard deviation of ≥3 sequential tacrolimus troughs, was dichotomized at MLVI > 2. Hospitalization was analyzed as a binary variable. Results The median age was 65, and 36% were female. In multivariate regression, increased NDI was associated with 20% increased odds of MLVI > 2 between 1–3 years post‐transplant (95% CI 1.1–1.3) but not MLVI > 2 between 3–5 years. NDI was associated with a 2.2 times higher hazard of hospitalization between 1–3 years post‐transplant (95% CI 1.1–4.4); but not between 3–5 years (HR 1.9, 95% CI 1.0–3.7). NDI was not significantly associated with increased hazard of rejection or graft failure/death. Adjusting for NDI, MLVI > 2 between 1–3 and 3–5 years was associated with a 30% higher hazard of rejection (95% CI 1.1–1.6), and between 1–3 years, a 40% increased hazard of graft failure/death (95% CI 1.2–1.5). We found geospatial hotspots of rejection with positive autocorrelation at Years 1–3 and 3–5 post‐transplant (Geary's C 0.97, p = 0.01). Conclusions Efforts to understand why individuals from disadvantaged neighborhoods experience poorer immunosuppression adherence may uncover targeted strategies to improve medication adherence for high‐risk groups. 10.1111/ctr.70412 http://onlinelibrary.wiley.com/termsAndConditions#vor |
| title | Neighborhood Deprivation Linked to Medication Level Variability in Liver Transplant Recipients |
| topic | Clinical Transplantation |
| url | https://onlinelibrary.wiley.com/doi/10.1111/ctr.70412 |