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Kidney Week

Abstract: SA-PO392

Childhood Opportunity Index and Pediatric Kidney Transplant Health

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

  • Farooque-Wooden, Jimshad, 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
  • Russell, Gregory B., 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
  • Chen, Ashton, Wake Forest University School of Medicine, Winston-Salem, North Carolina, United States
Background

Social Determinants of Health research has become increasingly important. The Childhood Opportunity Index (COI) is a composite of 29 variables affecting child health and well-being related to Health/Environment (HE), Social/Economic (SE), and Education (E). Research exploring the impact of COI on kidney transplant outcomes is lacking. Our aim was to assess association of COI with pediatric kidney transplant outcomes.

Methods

This was a single-center retrospective cohort study of kidney transplant recipients 0-18 years with post-transplant care at our center from 9/25/2012-12/31/2022. Exposures were overall COI and COI domains based on 2015 census tract data from diversitydatakids.org. Outcomes were graft survival, time to first biopsy-proven acute rejection (BPAR), number of BPARs, hospitalization rates, and transplant clinic no-show and cancellation rates. Statistical analyses included Kaplan-Meier, Cox proportional-hazards, and negative binomial regression models.

Results

Of the N=78 participants; median age at transplantation was 8.5 years [IQR 3,14]; median follow-up 5 years [IQR 4.1,7.0]. Event-free survival at 1 and 5 years was 100% and 92%. COI was not associated with graft survival, number of BPAR, hospitalization rates, or cancelled visits. COI-SE was inversely associated with time to first BPAR [p=0.010, HR=1.10, 95% CI 1.02-1.17]. Overall COI and COI-SE were inversely correlated with no-show rates [p=0.039, Beta coefficient=-0.41 per 5 units (95% CI -0.80,-0.02) and p=0.029, Beta coefficient=-0.43 per 5 units (95% CI -0.81,-0.05)]. Higher no-show rates were associated with worse graft survival [p=0.018, HR=1.38, 95% CI 1.06-1.79].

Conclusion

Lower COI-SE was associated with higher no-show rates which was associated with worse graft survival. Higher COI-SE was associated with shorter time to first BPAR, possible due to patients maintaining regular follow-up with more timely BPAR diagnosis. Higher no-show rates in individuals from areas of low COI-SE may result in delayed BPAR diagnosis, which could increase risk of graft failure. Future study can assess if COI predicts other transplant or kidney disease outcomes. To better understand the effects that lower COI may have at the individual level, questionnaires can be used to identify barriers to care such as affordability, perceived cost, transportation, or ability to attend appointments.

Funding

  • Other NIH Support