Kidney Week

Abstract: FR-PO0972

Geospatial Deprivation Is Associated with Lower Rates of Wait-Listing and Transplant Among Patients with ESKD

Session Information

• Transplantation: Clinical - Pretransplantation, Living Donation, and Policies
  November 07, 2025 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Transplantation

• 2102 Transplantation: Clinical

Authors

• Sahni, Prateek Vishwamitra, Columbia University, New York, New York, United States

Prateek Vishwamitra Sahni

• Buchalter, Robert B., Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, United States

Robert B. Buchalter, PhD, MPH

• Lahiri, Riya, Tufts University, Medford, Massachusetts, United States

Riya Lahiri

• Yu, Miko, Division of Nephrology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, United States

Miko Yu, MA

• Schold, Jesse D., Department of Surgery, University of Colorado - Anschutz Medical Campus, Aurora, Colorado, United States

Jesse D. Schold, MEd, MS, PhD

• Husain, Syed Ali, Division of Nephrology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, United States

Syed Ali Husain, MD, MA, MPH, FASN

• Mohan, Sumit, Columbia University, New York, New York, United States

Sumit Mohan, MD, MPH, FASN

Background

The initial proposal of the Increasing Organ Transplant Access (IOTA) payment model aimed to improve kidney transplant (KT) access for disadvantaged populations as defined by Medicaid coverage by providing an equity-based performance metric to health systems. We hypothesized that patients living in areas of high geospatial deprivation, as measured by area deprivation index (ADI) or social deprivation index (SDI), would have lower rates of waitlist placement and longer waiting time to KT than patients with Medicaid insurance.

Methods

We identified 567,230 incident end stage kidney disease (ESKD) patients from January 1^st, 2015 to December 31^st, 2021 using USRDS data. Their progression to waitlist and transplant was compared across low deprivation and high deprivation cohorts and patients with Medicaid vs patients with non-Medicaid insurance.

Results

Patients in low deprivation areas had higher rates of waitlisting (25%) and KT (43%) compared to patients in high deprivation areas (18% and 34%, respectively). Patients with Medicaid insurance had lower rates of waitlisting (16%) and transplant (34%) compared to patients with non-Medicaid insurance or from areas of high-deprivation (all p-values < 0.001).

Conclusion

While IOTA may be an effective policy for increasing access for disadvantaged patients, our results demonstrate that socioeconomic deprivation should be considered as a critical component in the IOTA model going forward.

Funding

• Other NIH Support

Digital Object Identifier (DOI)

• doi: 10.1681/ASN.2025frrebdd6