Association of Socioeconomic Disadvantage and Deceased Donor Kidney Transplant Graft Function

Abstract

Introduction

The study of social determinants of health in kidney transplantation has historically focused on equitable access, with limited evidence on the short- and long-term outcomes beyond graft loss and mortality. Our purpose is to identify and assess factors to ensure equitable outcomes after kidney transplant by identifying targets for health-care interventions in the posttransplant phase of care.

Methods

This is a single institution, cohort study of adults who received deceased donor kidney transplantation at a high-volume transplant center. Transplant recipients were stratified by social deprivation index (SDI) at the population mean of 60. The primary outcome is change in estimated glomerular filtration rate (eGFR).

Results

A total of 236 recipients were included, 48% (n = 113) were from higher deprivation neighborhoods (SDI >60). These recipients were younger, more likely to be black, and had lower estimated posttransplant survival scores. Both groups received grafts with similar kidney donor profile index scores. Despite similar discharge eGFR, recipients from high SDI neighborhoods had significantly lower eGFRs at all follow-up points, confirmed with mixed-effect analysis.

Conclusions

Recipients from neighborhoods with higher deprivation index have worse short- and long-term graft function, despite being younger, having lower estimated posttransplant survival scores, and similar graft kidney donor profile index at transplantation. This unexplained compromise in graft function is an opportunity for community-based interventions after recipients receive deceased donor kidney transplantation.