Abstract: SA-PO1092
Mortality by Rurality Among Kidney Transplant Recipients in the United States over 20 Years
Session Information
- Transplantation: Clinical - Postkidney Transplant Outcomes and Potpourri
November 08, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2102 Transplantation: Clinical
Authors
- Al Ammary, Fawaz, University of California Irvine, Irvine, California, United States
- Ku, Elaine, University of California San Francisco, San Francisco, California, United States
- Rule, Andrew D., Mayo Clinic Minnesota, Rochester, Minnesota, United States
- Lincoln, Karen D, University of California Irvine, Irvine, California, United States
- Adeyemo, Simeon, University of California Irvine, Irvine, California, United States
Background
Kidney transplantation is optimal for most patients with end-stage kidney disease, offering superior survival compared to dialysis. Recipients require lifelong immunosuppression and management of chronic comorbidities, making access to care essential. Rural patients may face geographic and provider-related barriers to quality long-term care. This study examined mortality among kidney transplant recipients by rural versus non-rural residence to inform future care strategies.
Methods
We conducted a retrospective cohort study of 370,937 adult first-time kidney transplant recipients in the U.S. between 1/1/2000, and 12/31/2024, using data from the Scientific Registry of Transplant Recipients. The exposure was residence rurality, as per Rural-Urban Commuting Area codes. The primary outcome was mortality. Recipients were followed from the date of transplant until death, 20 years post-transplant, or administrative censoring on 12/31/2024, whichever came first. Mortality was estimated using Kaplan-Meier curves, and associations were assessed with multivariable Cox proportional hazards models.
Results
The median [IQR] age was 54 years [43–63] years among rural recipients, and 53 years [42-63] among non-rural recipients. Estimated mortality at 5, 10, and 20-years post-transplant was 13%, 31%, and 60% among non-rural recipients, compared to 15%, 35%, and 67% among rural recipients. In adjusted models, rural residence was associated with a 10% higher risk of mortality compared to non-rural residence (adjusted hazard ratio = 1.10; 95% CI, 1.08–1.11).
Conclusion
Rural kidney transplant recipients in the U.S. experience higher long-term mortality than their non-rural counterparts. These findings underscore the need for targeted programs to improve long-term post-transplant care for rural patients.
Funding
- NIDDK Support