Importance of social deprivation by neighborhood on the pathway from referral to kidney transplantation

Background

Despite the known impact of social deprivation on kidney transplant access, no instrument exists that quantifies the likelihood of receiving a transplant using neighborhood-level socioeconomic deprivation.

Methods

Patients referred for kidney transplant evaluation from July 2017 and January 2022 were evaluated. Patients' addresses were geocoded using the DeGAUSS (Decentralized Geomarker Assessment for Multi-Site Studies) system, and deprivation index was generated. An internally validated prediction score was created to quantify a patient's risk of not being waitlisted or transplanted after referral.

Results

Of the 4,852 patients referred for kidney transplant, 3,816 (78.6%) were never successfully waitlisted or transplanted. Patients from the highest deprivation quartile were less likely to be waitlisted or transplanted (84.0%, n = 1,007/1,199) than those from the lowest deprivation quartile (74.3%, n = 893/1,202). Patients who were male, older, spent more time on dialysis, and had higher deprivation levels were less likely to be waitlisted or transplanted (area under the curve 71.2%). Assigning scores based on odds ratios allowed creation of the Kidney Transplant Access Prediction score, which assigns points for male sex, deprivation index ≥46, age ≥57, being on hemodialysis, and spending ≥24 months on dialysis. A score ≥4 had a 93.7% rate of never being waitlisted or transplanted and identified those at highest risk with a 72% sensitivity on validation testing.

Conclusion

Using factors known at referral, we have created a prediction tool to evaluate who is less likely to successfully receive a kidney transplant. Using this model, centers can develop targeted interventions, which can increase equitable access to kidney transplantation.