Socioeconomic Disparities in Long-Term Outcomes After Pediatric Liver Transplantation in a Universal Healthcare System: A Population-Based Study

Toshifumi Yodoshi; M. Ellen Kuenzig; Furong Tang; Mari Kajiwara Saito; Andréanne Zizzo; Blayne Amir Sayed; Vicky Lee Ng; Eric Ian Benchimol

doi:10.1016/j.ajt.2026.07.024

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Socioeconomic Disparities in Long-Term Outcomes After Pediatric Liver Transplantation in a Universal Healthcare System: A Population-Based Study

Journal article

Peer reviewed

Socioeconomic Disparities in Long-Term Outcomes After Pediatric Liver Transplantation in a Universal Healthcare System: A Population-Based Study

Toshifumi Yodoshi, M. Ellen Kuenzig, Furong Tang, Mari Kajiwara Saito, Andréanne Zizzo, Blayne Amir Sayed, Vicky Lee Ng and Eric Ian Benchimol

American journal of transplantation

07/25/2026

DOI: 10.1016/j.ajt.2026.07.024

PMID: 42501919

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Abstract

We conducted a population-based cohort study of pediatric liver transplantation (LT) in Ontario, Canada, a universal healthcare setting, to quantify survivorship burden relative to matched general-population controls and assess whether socioeconomic status (SES) modified these differences. First, isolated pediatric LTs (1991–2021) were linked to provincial administrative data and matched 1:5 on sex and birth year to general-population controls. Outcomes were mortality, chronic conditions, de novo cancers, and live births, with prespecified SES interaction analyses. Among 449 LT recipients and 2,245 controls (median age 1.9 years), 20-year survival was 78%. At 10 years, LT recipients had higher cumulative incidence of mood disorders (16.1% vs 8.77%; IRR 3.61, 95% CI 2.9–4.5) and de novo cancer (7.83% vs 0.19%; IRR 25.1, 95% CI 12.1–52.0), with cancer excess concentrated in the first 5 years. In a female-only landmark analysis beginning at age 15, live-birth incidence was similar between groups (IRR 0.75, 95% CI 0.39–1.44), suggesting childhood LT does not necessarily preclude later family-building. Lower neighborhood income predicted higher post-LT mortality (adjusted HR 2.1, 95% CI 1.2–3.7). Despite universal healthcare, socioeconomic disadvantage was associated with worse long-term outcomes; integrating social determinants of health into survivorship care is needed.

Mental Health

Chronic comorbidity

De novo cancer

Health inequalities

Paediatric liver transplantation

Population-based cohort

Post-transplant complications

Socioeconomic status

Survivorship

Details

Title: Subtitle: Socioeconomic Disparities in Long-Term Outcomes After Pediatric Liver Transplantation in a Universal Healthcare System: A Population-Based Study
Creators: Toshifumi Yodoshi - Hospital for Sick Children
M. Ellen Kuenzig - Western University
Furong Tang - SickKids Foundation
Mari Kajiwara Saito - University of London
Andréanne Zizzo - Western University
Blayne Amir Sayed - Hospital for Sick Children
Vicky Lee Ng - Hospital for Sick Children
Eric Ian Benchimol - SickKids Foundation
Resource Type: Journal article
Publication Details: American journal of transplantation
DOI: 10.1016/j.ajt.2026.07.024
PMID: 42501919
NLM abbreviation: Am J Transplant
ISSN: 1600-6135
eISSN: 1600-6143
Publisher: Elsevier Inc
Language: English
Electronic publication date: 07/25/2026
Academic Unit: Stead Family Department of Pediatrics; Gastroenterology, Hepatology, Pancreatology, and Nutrition
Record Identifier: 9985217037502771

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