Impact of Community Factors on the Donor Quality Score in Liver Transplantation

Impact of Community Factors on the Donor Quality Score in Liver Transplantation by Giovanna Saracino MS, Southern Methodist University, 1998 MS, Sapienza University of Rome, 1994 Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Public Health Walden University August 2019 Abstract An increasing prevalence of metabolic syndrome and obesity has been linked to the rise in transplant indication for cryptogenic cirrhosis and nonalcoholic fatty liver disease (NAFLD), creating a growing challenge to public health. NAFLD liver transplant (LT) candidates are listed with low priority, and their waiting mortality is high. The impact of community/geographic factors on donor risk models is unknown. The purpose of thisAn increasing prevalence of metabolic syndrome and obesity has been linked to the rise in transplant indication for cryptogenic cirrhosis and nonalcoholic fatty liver disease (NAFLD), creating a growing challenge to public health. NAFLD liver transplant (LT) candidates are listed with low priority, and their waiting mortality is high. The impact of community/geographic factors on donor risk models is unknown. The purpose of this study was to develop a parsimonious donor risk-adjusted model tailored to NAFLD recipients by assessing the impact of donor, recipient, transplant, and external factors on graft survival. The theoretical framework was the social ecological model. Secondary data were collected from 3,165 consecutive recipients from the Scientific Registry of Transplant Recipients and Community Health Scores, a proxy of community health disparities derived from the Robert Wood Johnson Foundation’s community health rankings. Data were examined using univariate and multivariate analyses. The donor riskadjusted model was developed using donor-only factors and supplemented with recipient and transplant factors, classifying donors as low, medium, and high risk. NAFLD residents in high-risk counties had increased likelihood of liver graft failure. Findings may be used to allocate high-risk donors to a subset of NAFLD with excellent outcomes, increasing the donor pool and decreasing mortality on the wait list. Impact of Community Factors on the Donor Quality Score in Liver Transplantation by Giovanna Saracino MS, Southern Methodist University, 1998 MS, Sapienza University of Rome, 1994 Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Public Health Walden University August 2019 Dedication I would like to dedicate this dissertation to my beloved parents, Nicola Saracino and Maria Nicoletta Azzanese, without whom none of my success would be possible. Acknowledgments First and foremost, I would like to thank my Ph.D. supervisory committee chair, Dr. Srikanta Banerjee, for his constant guidance and support to perform this research work and develop this dissertation. I thank him for his mentorship that strengthened and challenged me to strive in the successful execution of the research. I would also like to express my gratitude to Dr. Hebatullah Tawfik for her excellent constructive critiques, significant support, and encouragement, and to Dr. Raymond Panas for all the guidance and support provided. In full gratitude, I would like to acknowledge Dr. Sumeet Asrani, my liver transplant research mentor, for providing me with valuable advice during this research work, and for his professional assistance. A special acknowledgment is due to Baylor Annette C. and Harold C. Simmons Transplant Institute for the overall support towards my Ph.D. studies. Lastly, I would like to thank all my friends, colleagues, and family members for their support and encouragement during my studies. The data reported here have been supplied by the Minneapolis Medical Research Foundation as the contractor for the Scientific Registry of Transplant Recipients (SRTR). The interpretation and reporting of these data are my responsibility and in no way should be seen as an official policy of or interpretation by the SRTR or the U.S. Government.