Lower Child Opportunity Index is associated with increased health care utilization following pediatric liver transplantation.

Social determinants of health are known to lead to adverse health outcomes, including high acute care utilization. The mechanisms underlying health care disparities among children who have undergone liver transplantation (LT) are poorly understood. To elucidate the relationship between social determinants of health and health care utilization among children (<18 y old at the time of LT) who have undergone LT, we performed a retrospective study merging data from the Organ Procurement and Transplantation Network (OPTN) and the Pediatric Health Information System (PHIS) database. Children with lower Child Opportunity Index (COI) scores, a composite measure of social determinants of health, were admitted for 28% more days in the first year and 29% more days over the first 2 years after LT, as compared to children with higher COI. We also observed that in the second year after LT, children with a lower COI were more often admitted with a complication of LT (23%) than those with a higher COI (18%). COI may be a useful composite screening instrument for clinical teams to target resources and limit acute care use after LT.