Abstract
BACKGROUND: The Environmental Justice Index (EJI) measures neighborhood level environmental, social, and health disparities. The Social-Environmental Ranking (SER) components of the EJI is used when linking to health outcomes. Higher SER scores (≥0.75) indicate greater environmental injustice and potential health inequities. This study assesses whether EJI's through SER can inform the care of liver transplantation (LT) patients in Houston, Texas. METHODS: This single-center, retrospective analysis was conducted on LT recipients between January 2008 and December 2024. Patient addresses were linked to census tract-level EJI data and stratified at a 0.75 score threshold. Propensity score matching (PSM) was performed. Overall survival (OS) was assessed pre and post matching. RESULTS: A total of 2,030 LT recipients were stratified by SER score (<0.75 vs. ≥0.75). Pre-matching, high SER patients were more often female (44.4% vs. 38.9%, p = 0.02), non-Hispanic Black (14.9% vs. 6.7%) or Hispanic (36.2% vs. 16.1%, p < 0.001), had public insurance (44.0% vs. 33.8%, p < 0.001), were unemployed at transplant (27.4% vs. 31.9%, p = 0.046), and had lower education levels (p < 0.001). They also had higher BMI (28.90 vs. 28.05, p = 0.024), longer waitlist times (103 vs. 71 days, p = 0.036), more diabetes (35.4% vs. 28.4%, p = 0.002), CMV positivity (79.3% vs. 71.0%, p < 0.001), and multi-organ transplants (18.6% vs. 14.4%, p = 0.015). Pre-LT, more were hospitalized on the floor (21.8% vs. 14.0%) and fewer in ICU (40.3% vs. 44.4%, p < 0.001). PSM yielded 619 matched pairs with covariate balance (SMD < 0.1). OS and graft survival did not differ by SER strata before or after matching (p > 0.05). CONCLUSION: These findings suggest that EJI is associated with pre-transplant variables and may help identify patients in need of social supports. However, individual patient factors seem to determine post-LT survival.