Published Online
on April 7, 2009

A more recent version of this article appeared on May 1, 2009

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Original Article

Socioeconomic Position and Graft Failure in Pediatric Heart Transplant Recipients

Tajinder P. Singh^1,4; Kimberlee Gauvreau²; Heather J. Bastardi³; Elizabeth D. Blume¹ and John E. Mayer¹

¹ Children's Hospital Boston and Harvard Medical School, Boston, MA;
² Children's Hospital Boston and Harvard School of Public Health, Boston, MA;
³ Children's Hospital, Boston, MA

⁴ E-mail: tp.singh{at}cardio.chboston.org

Background—Socioeconomic (SE) position may affect availability of resources, health-related behavior and outcomes. We assessed whether patient SE position, determined for the block group of patient residence (average population 1000, smallest census unit with SE data), is associated with graft failure in pediatric heart transplant recipients.

Methods and Results—We used the US Census 2000 database to derive a composite SE score for the block group of residence for all patients who underwent their first heart transplant at Children's Hospital Boston between 1991 and 2005 (n=135). Cox proportional hazards models were used to determine the risk of graft failure (death or re-transplant) in the lowest tertile SE group (low SE group) compared to the remaining 2/3 patients (controls). The two groups were similar with respect to age, gender, diagnosis and year of transplant. White race was less frequent in low SE group (64% versus 90%, P=0.001). Graft failure occurred in 46 transplant recipients (40 deaths, 6 re-transplant). Low SE group (hazard ratio (HR) 2.4, 95% confidence interval (CI) 1.3-4.3) and nonwhite race (HR 2.7, CI 1.4-5.2) were both associated with higher risk of graft failure. In a multivariable model controlling for diagnosis and pre-transplant support, race and low SE position (HR 2.0, 95% CI 1.0-3.7, P=0.04) remained associated with graft failure. Low SE position group had a higher incidence rate of graft rejection and was at a higher risk of late rejection.

Conclusions—Low SE position may be an independent risk factor for graft failure in pediatric heart transplant recipients.

Key Words: follow-up studies • pediatrics • risk factors • survival • transplantation