{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,4]],"date-time":"2026-07-04T02:36:03Z","timestamp":1783132563620,"version":"3.54.6"},"reference-count":23,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2025,12,11]],"date-time":"2025-12-11T00:00:00Z","timestamp":1765411200000},"content-version":"vor","delay-in-days":10,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2025,12,1]],"date-time":"2025-12-01T00:00:00Z","timestamp":1764547200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Transplantation"],"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Neighborhood deprivation is associated with adverse outcomes post\u2010liver transplantation in pediatric recipients. We examined the association between neighborhood deprivation index (NDI) and medication level variability index (MLVI), T\u2010cell mediated rejection (TCMR), and graft failure\/death in adult liver transplant recipients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective cohort study of 1485 adult liver\u2010transplant recipients with &gt;1 year follow\u2010up. NDI was calculated at the census tract level. MLVI, the standard deviation of \u22653 sequential tacrolimus troughs, was dichotomized at MLVI\u00a0&gt;\u00a02. Hospitalization was analyzed as a binary variable.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The median age was 65, and 36% were female. In multivariate regression, increased NDI was associated with 20% increased odds of MLVI\u00a0&gt;\u00a02 between 1\u20133 years post\u2010transplant (95% CI 1.1\u20131.3) but not MLVI\u00a0&gt;\u00a02 between 3\u20135 years. NDI was associated with a 2.2 times higher hazard of hospitalization between 1\u20133 years post\u2010transplant (95% CI 1.1\u20134.4); but not between 3\u20135 years (HR 1.9, 95% CI 1.0\u20133.7). NDI was not significantly associated with increased hazard of rejection or graft failure\/death. Adjusting for NDI, MLVI\u00a0&gt;\u00a02 between 1\u20133 and 3\u20135 years was associated with a 30% higher hazard of rejection (95% CI 1.1\u20131.6), and between 1\u20133 years, a 40% increased hazard of graft failure\/death (95% CI 1.2\u20131.5). We found geospatial hotspots of rejection with positive autocorrelation at Years 1\u20133 and 3\u20135 post\u2010transplant (Geary's C 0.97,\n                      <jats:italic>p<\/jats:italic>\n                      = 0.01).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Efforts to understand why individuals from disadvantaged neighborhoods experience poorer immunosuppression adherence may uncover targeted strategies to improve medication adherence for high\u2010risk groups.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/ctr.70412","type":"journal-article","created":{"date-parts":[[2025,12,12]],"date-time":"2025-12-12T07:21:00Z","timestamp":1765524060000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Neighborhood Deprivation Linked to Medication Level Variability in Liver Transplant Recipients"],"prefix":"10.1111","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1512-9996","authenticated-orcid":false,"given":"Laila","family":"Fozouni","sequence":"first","affiliation":[{"name":"Department of Medicine University of California  San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2935-0245","authenticated-orcid":false,"given":"Giuseppe","family":"Cullaro","sequence":"additional","affiliation":[{"name":"Department of Medicine Division of Digestive and Liver Diseases Columbia University  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6341-0360","authenticated-orcid":false,"given":"Ann","family":"Lazar","sequence":"additional","affiliation":[{"name":"UCSF Department of Epidemiology and Biostatistics Department of Preventive and Restorative Dental Sciences Division of Biostatistics  San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2092-6380","authenticated-orcid":false,"given":"Jennifer C.","family":"Lai","sequence":"additional","affiliation":[{"name":"Department of Medicine Division of Gastroenterology and Hepatology University of California, San Francisco  San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5565-6670","authenticated-orcid":false,"given":"Sharad I.","family":"Wadhwani","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Division of Gastroenterology Hepatology and Nutrition University of California  San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,12,11]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.transproceed.2018.02.059"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.aohep.2023.101283"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.aohep.2023.101127"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajt.14276"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cardfail.2019.04.017"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.socscimed.2022.115049"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/pros.24320"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12889\u2010019\u20108123\u20100"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/lt.23930"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajt.15786"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11524\u2010006\u20109094\u2010x"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1136\/jech.57.3.186"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1093\/jamia\/ocx128"},{"key":"e_1_2_10_15_1","unstructured":"R.Morrill J.Cromartie andG.Hart \u201cRural\u2010Urban Commuting Area Codes (RUCAs) \u201dRural Health Research Center. Accessed 11\/5\/24 https:\/\/depts.washington.edu\/uwruca\/ruca\u2010uses.php."},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10552\u2010022\u201001555\u20100"},{"key":"e_1_2_10_17_1","unstructured":"OPTN\/SRTR 2020 Annual Data Report: Liver.2020."},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1111\/liv.13651"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1097\/LVT.0000000000000127"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1111\/ctr.15442"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1038\/jes.2016.10"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.annepidem.2018.11.008"},{"key":"e_1_2_10_23_1","unstructured":"C.BrokampandE.Manning.Giomarker\u2010io. Github https:\/\/github.com\/geomarker\u2010io\/dep_index."},{"key":"e_1_2_10_24_1","unstructured":"B.Glassman \u201cThe Multidimensional Deprivation Index Using Different Neighborhood Quality Definitions \u201d SEHSD Working Paper No. 2020\u201008 (U.S. Census Bureau Social Economic and Housing Statistics Division 2020)."}],"container-title":["Clinical Transplantation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ctr.70412","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/ctr.70412","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ctr.70412","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,8]],"date-time":"2026-03-08T17:35:09Z","timestamp":1772991309000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/ctr.70412"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12]]},"references-count":23,"journal-issue":{"issue":"12","published-print":{"date-parts":[[2025,12]]}},"alternative-id":["10.1111\/ctr.70412"],"URL":"https:\/\/doi.org\/10.1111\/ctr.70412","archive":["Portico"],"relation":{},"ISSN":["0902-0063","1399-0012"],"issn-type":[{"value":"0902-0063","type":"print"},{"value":"1399-0012","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12]]},"assertion":[{"value":"2025-04-22","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-11-21","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-12-11","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70412"}}