Abstract: SA-PO0691
Social Drivers of Health and Pediatric Kidney Transplant Allograft Outcomes: A PEDSnet Study
Session Information
- Pediatric Nephrology: Transplantation, Hypertension, AKI, Genetics, and Developmental Diseases
November 08, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Pediatric Nephrology
- 1900 Pediatric Nephrology
Authors
- Chen, Ashton, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
- Dawson, Anne E., Nationwide Children's Hospital, Columbus, Ohio, United States
- Denburg, Michelle, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
- Dixon, Bradley P., Children's Hospital Colorado, Aurora, Colorado, United States
- Flynn, Joseph T., Seattle Children's Hospital, Seattle, Washington, United States
- Gluck, Caroline A., Nemours Children's Hospital Delaware, Wilmington, Delaware, United States
- Mitsnefes, Mark, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
- Mohamed, Tahagod, Nationwide Children's Hospital, Columbus, Ohio, United States
- Moxey-Mims, Marva M., Children's National Hospital, Washington, District of Columbia, United States
- Nguyen, Nhat Thi Duy, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
- Patel, Ruby Vishnu, Stanford University School of Medicine, Stanford, California, United States
- Tal, Leyat, Texas Children's Hospital, Houston, Texas, United States
- Smith, Jodi M., Seattle Children's Hospital, Seattle, Washington, United States
- Verghese, Priya S., Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois, United States
- Zelinski, Allison, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
Background
Social drivers of health (SDoH) are non-medical factors that influence health outcomes and health equity. The effect of SDoH on kidney allograft outcomes has not been well-studied in children. We investigated the effect of SDoH on outcomes in pediatric kidney transplant patients.
Methods
In a multi-center retrospective cohort study, using PEDSnet learning health system (LHS), data were extracted from the electronic health record using bioinformatics methods. Inclusion criteria were patients 0-21 years old with a primary kidney transplant from 1/1/09–3/31/24. Those with multi-organ transplants, missing donor information, and incomplete follow-up were excluded. Exposures were language, insurance type, distance to transplant center, area deprivation index (ADI), social vulnerability index (SVI), and child opportunity index (COI). Primary outcome was graft survival; secondary outcome was acute rejection. Kaplan-Meier estimates were used for graft survival. Multivariate Cox proportional hazards models estimated associations of exposure with outcome.
Results
Of N=2,339 transplant recipients: 41% were female; 37% had living donor; median age at transplant 13.3 years [IQR 7.1,16.7]; median follow-up was 5.4 years [IQR 2.8, 8.7]. Overall graft survival at 5 years was 98.5% (95%-CI: 97.9, 99.1). In multivariate Cox regression analysis, public insurance and shorter distance to transplant center were associated with decreased graft survival and shorter distance to the medical center was associated with increased risk of acute rejection. In a sensitivity analysis, greater SVI in Household Characteristics (Theme 2) and lower SVI in Racial and Ethnic Minority Status (Theme 3) were associated with higher rejection risk.
Conclusion
Public insurance may be a good marker for those that need extra resources or support to maintain graft function. Minority status, although associated with lower rejection risk, could represent undiagnosed rejection, which could negatively impact graft survival for underrepresented minorities. SDoH related to household characteristics may be an area to implement patient-level interventions, within the LHS, aimed at improving health equity for pediatric kidney transplant recipients.
Funding
- Other NIH Support