It looks like living in the boonies (URBAN DICTIONARY: BOONIES) does not make a big difference in pediatric liver transplantation (LT) outcomes (J Pediatr 2013; 162: 313-8).
The authors analyzed 3307 pediatric patients using the United Network Organ Sharing (UNOS) database between 2004-09.
Key outcomes for rural location:
- Associated with greater risk of allograft rejection in the first 6 months after LT with an OR 1.27 (27% compared with 22.9% of urban patients). The risk allograft rejection was not statistically significant at 1 year post LT (OR 1.18).
- Associated with lower risk of post transplantation lymphoproliferative disorder (PTLD) with an OR of 0.64. In total, 2.4% of rural patients experienced PTLD compared with 3.8% of urban patients.
- Allograft loss and survival were similar for rural patients as for patients: 21.3% and 14.1% respectively compared with 20.7% and 12.7%.
The opposite risk ratios with regard to rejection and PTLD indicates that rural status may have greater rates of nonadherence with maintenance immune-suppression. However, the lack of a larger discrepancy in outcomes comes as a pleasant surprise, particularly as rural status is a known risk factor for worse health outcomes in many other complex chronic diseases. Perhaps, this study validates the high level of skill and teaching on the part of pediatric liver transplant teams as well.