Material economic hardship is associated with adverse 1-year outcomes after pediatric liver transplantation: Prospective cohort results from the multi-center SOCIAL-Tx study.

Pediatric liver transplant outcomes exhibit disparities, necessitating identification of modifiable risk factors to develop targeted interventions. We characterized associations between household material economic hardship (e.g., financial barriers to housing or food) and pediatric liver transplant outcomes. We recruited pediatric liver transplant recipients <18 years at the time of transplant across 8 U.S. centers. Our primary exposure was >/=1 household material economic hardship (i.e., food insecurity, housing instability, transportation challenges, or utility concerns), measured using the Accountable Healthcare Communities screening tool. Outcomes included 90-day and 1-year (1) total inpatient-bed days, and (2) episodes of T-cell mediated rejection (TCMR). Of the 77 participants (36% female), 34% reported household material economic hardship. Such hardship was associated with increased total inpatient bed-days within 90 days (ratio estimate: 1.45, 95%CI: 1.08, 1.96); the association persisted after adjusting for health literacy, insurance, and transplant center (ratio estimate: 1.37, 95%CI: 1.02, 1.84). Household material economic hardship was associated with total inpatient bed-days within 1-year post-transplant (ratio estimate: 3.2, 95%CI: 1.1, 10.1); associations diminished in multivariable analyses (ratio estimate: 2.2, 95%CI: 0.7, 6.9). Household material economic hardship was associated with increased risk of TCMR within 1 year of transplant (RR: 2.1, 95%CI: 1.1, 4.2); the association diminished in propensity-score matched analyses (RR: 1.4, 95%CI: 0.9, 2.3). Our findings highlight the adverse influence of household material economic hardship on pediatric liver transplant outcomes within the first year. Targeted social risk assistance and adjustment strategies offer actionable avenues to mitigate these challenges and enhance outcomes in pediatric liver transplant recipients.