# The Influence of Social Determinants of Health on the Survival of Heart Transplants in the Pediatric Age: An Analysis of a Mexican Cohort and Its Comparison with Latin America and the Caribbean

## TL;DR

This study examines how social factors affect heart transplant survival in Mexican children and compares outcomes with other Latin American and Caribbean countries.

## Contribution

The study identifies specific social determinants of health that increase mortality risk in pediatric heart transplant recipients in Mexico.

## Key findings

- The first-year survival rate for pediatric heart transplants in Mexico was 76.3 per 100 transplants.
- Social determinants like malnutrition, low parental education, and lack of transitional care significantly increased mortality risk.
- Mexico performs 42% of all pediatric heart transplants in the country, but Latin America and the Caribbean have lower transplant rates and survival compared to developed nations.

## Abstract

Background/Objectives: A heart transplantation (HT) is the definitive treatment for heart failure. There is a difference in the success between national HT programs in developed countries and those in Central America, South America, and the Caribbean (LAC), and social determinants of health (SDHs) can directly influence this. The objectives of this study were to describe the survival since the beginning of the HT program of a national pediatric institute in Mexico City and to compare it with the results of a systematic review of LAC. Methods: A cohort study of a pediatric hospital (which performed 42% of the pediatric HTs in Mexico) was performed since the beginning of the HTs program in 2001. Clinical variables related to the transplants were identified, and the SDHs were divided into three categories: personal, family, and community. A systematic literature review was performed using keywords and a search in the medical indexes of LAC countries. The statistical analysis included descriptive statistics and a bivariate survival analysis. A risk calculation was estimated using the hazard ratio (HR) of the SDHs. Results: A total of 38 HTs were performed, the median age was 7 (4–16) years, and 22 (58%) were men. The leading cause was cardiomyopathy in 20 (53%) cases. The first-year survival rate was 76.3 per 100 HTs. The SDHs that increased the risk of death were suboptimal immunosuppression, the persistence of malnutrition, parental education, the distance from the center, the socioeconomic level, and the absence of transitional care. Conclusions: This cohort of pediatric patients with HTs resulted in the identification of risk variables of personal and community SDHs for mortality in the first and fifth years. Chronic rejection occurred in 50%, and the absence of transitional care to adulthood was the variable with the highest risk. The systematic review identified Mexico as the country with the second-highest frequency of HTs, and our cohort represented 42% of the total number of transplants in the country. Numerically, LAC has a lower frequency of transplants and survival in the first year compared to other developed countries, possibly due to a gap associated with organizational justice.