P198 Socio-economic deprivation adversely affects survival following liver transplantation

Abstract

Introduction Liver transplantation is the only effective treatment for end stage liver disease. It is unclear how socio-economic deprivation affects survival in patients with severe liver disease both transplanted and not listed for transplant. Methods All notes for adult patients assessed for liver transplantation in Scotland between January 2009 and December 2017 were reviewed. Patients with incomplete data, those who died before transplant, were listed for dual transplant or who were removed from the list were excluded (n=1045). We assessed survival using Kaplan-Meier curves to compare those transplanted to those not listed. Patients not listed as they had a hepatocellular carcinoma outside criteria, or were too well or too unwell to be listed were excluded from the relevant analyses to lower the risk of bias (n=253). We also assessed the effect of socio-economic deprivation by comparing survival in the most and least deprived groups in the transplanted and not listed groups. A significance level of p Deprivation was assessed using the Scottish Index of Multiple Deprivation (SIMD) and groups were paired for analysis (group 1 most deprived; group 5 least deprived) Results When including all patients those transplanted (n=562; 103 deaths) had a significantly better survival than those not listed (n=230; 139 deaths) (Mean survival 2219 days (95% CI 1912–2526) vs. mean survival 645 days (95% CI 563–726). (Log rank p There was no difference in survival when comparing the most deprived to the least deprived (SIMD 1 (n=84; 56 deaths) vs. SIMD 5 (n=32; 16 deaths)) in those patients not listed for transplant. (Mean survival 658 days (95% CI 474–842) vs. mean survival 680 days (95% CI 367–994). (Log rank p=0.969). When comparing survival in the most deprived (n=133; 32 deaths) to the least deprived (n=86; 13 deaths) in those patients that were transplanted, patients from the more deprived areas had a poorer survival. (Mean survival 1373 days (95% CI 1027–1719) vs. mean survival 1998 days (95% CI 1596–2400) (Log rank p=0.046).(Figure 1). Conclusions Overall liver transplantation gives a significant survival advantage compared to those not listed. Patients from more affluent areas of Scotland have improved survival to those from less affluent areas when transplanted. No difference is seen in those patients not transplanted.