Impact of Social Vulnerability on Future Risk of Metabolic Complications and Survival in Female Liver Transplant Recipients

BACKGROUND: Healthcare outcomes research has historically used males as the reference; however, such a comparison ignores key biological processes. Thus, the present study aimed to evaluate metabolic health in female liver transplant (LT) recipients, using female sex itself as the reference standard. METHODS: Social vulnerability index (SVI) is a composite marker of external stressors to individual health, with a high SVI indicative of higher social vulnerability. Kaplan-Meier curves were constructed to determine the association between SVI and the likelihood of developing metabolic complications, including type 2 diabetes, obesity, hypertension, and all-cause mortality, 36 mo after LT in 252 adult females. RESULTS: The baseline clinical profile was similar between patients with low (below median) and high (above median) SVI. Black females had a higher SVI than non-Hispanic White (hereafter, White) females. No difference in overall mortality or new-onset metabolic diseases was noted when patients were stratified based on high versus low SVI. Among patients with high SVI, Black females had a higher incidence of post-LT obesity and type 2 diabetes than White females. Survival was also lower in Black females with high SVI when compared with White females. When females with a low SVI were stratified according to ethnicity, no significant differences in survival or risk of metabolic conditions were noted. CONCLUSIONS: As defined by SVI, these data underscore the need to better understand healthcare disparities in LT patients to improve clinical outcomes.