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Kidney Week

Abstract: SA-PO388

Social Determinants of Health and Kidney Transplant Outcomes in Youth

Session Information

  • Pediatric Nephrology - III
    November 04, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Pediatric Nephrology

  • 1900 Pediatric Nephrology

Authors

  • Chen, Ashton, Wake Forest University School of Medicine, Winston-Salem, North Carolina, United States
  • Russell, Gregory B., Wake Forest University School of Medicine, Winston-Salem, North Carolina, United States
  • Vincent, Carol, Wake Forest University School of Medicine, Winston-Salem, North Carolina, United States
  • South, Andrew M., Wake Forest University School of Medicine, Winston-Salem, North Carolina, United States
  • Bagley, Kiri W., Wake Forest University School of Medicine, Winston-Salem, North Carolina, United States
Background

Investigating how social determinants of health (SDoH) affect clinical outcomes is important in achieving health equity. The effect of SDoH on the pediatric transplant recipients is not well understood. Our aim was to investigate the association of adverse SDoH with kidney allograft outcomes in a diverse population of youth from a broad referral area.

Methods

In this single-center retrospective cohort study, data were extracted from the electronic health record using biomedical informatics methods. Inclusion criteria were youth 0-18 years who received a kidney transplant and had post-transplant care at our center from 9/25/2012 to 12/31/2022. Exposures were insurance type (public vs private), distance to transplant center, preferred language, and area deprivation index (ADI). Outcomes were graft survival, time to first biopsy-proven acute rejection (BPAR), and number of BPAR episodes. We used Kaplan-Meier estimates for graft survival and time to first BPAR. Cox proportional hazards regression models estimate the associations of exposures with time-to-event outcomes. For BPAR episodes, a negative binomial regression model, adjusted for time followed, assessed the relationship between outcome and exposure.

Results

Of 78 participants, 37% were female; median age at transplant was 8.5 years [IQR 3,14]; median follow-up was 5.0 years [IQR 4.1,7.0]. Event-free survival at 1 and 5 years was 100% and 92%. Median number of BPAR was 0 [IQR 0-2]. Public insurance, greater distance to transplant center, non-English language, and higher ADI were not associated with higher risk of graft failure or time to first BPAR. However public insurance was associated with greater BPAR episodes on unadjusted analysis [OR 3.33,CI 1.19-9.30] and after adjusting for race [OR 3.07,CI 1.08-8.73].

Conclusion

Several adverse SDoH were not associated with worse graft survival or faster time to BPAR in this interim analysis of pediatric kidney transplant recipients. However, having public insurance was associated with a greater number of BPAR. Public insurance may represent a risk marker for patients with greater healthcare needs and who may experience inequities in care. Ongoing quantitative and qualitative studies will clarify health-related social needs and patient experiences in this population to identify targeted interventions to achieve more equitable and optimal transplant outcomes.

Funding

  • Other NIH Support