Kidney Week

Abstract: SA-PO094

Contrasting Relationships Between Deprivation, Kidney Transplantation, and Live Donation

Session Information

• Transplantation: Recipient and Donor Assessment
  October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Transplantation

• 1802 Transplantation: Clinical

Authors

• Gillis, Keith, University of Glasgow, Glasgow, United Kingdom

Keith Gillis,

• Glen, Julie, NHS Greater Glasgow and Clyde, Glasgow, United Kingdom

Julie Glen,

• Lees, Jennifer S., University of Glasgow, Glasgow, United Kingdom

Jennifer S. Lees,

• Ralston, Maximilian Rothwell, NHS Greater Glasgow and Clyde, Glasgow, United Kingdom

Maximilian Rothwell Ralston,

• Geddes, Colin C., NHS Greater Glasgow and Clyde, Glasgow, United Kingdom

Colin C. Geddes,

• Stevenson, Karen S., NHS Greater Glasgow and Clyde, Glasgow, United Kingdom

Karen S. Stevenson,

• Traynor, Jamie P., NHS Greater Glasgow and Clyde, Glasgow, United Kingdom

Jamie P. Traynor,

• Mark, Patrick B., University of Glasgow, Glasgow, United Kingdom

Patrick B. Mark,

Group or Team Name

• Glasgow Renal Research Group

Background

Socioeconomic deprivation (SED) is associated with reduced access to pre-emptive and live kidney donation for end stage kidney disease (ESKD). We investigated the association between SED and access to, and progression through, potential live donor (PLD) assessment.

Methods

Retrospective analyses of routinely collected healthcare data were performed. A postcode of residence-based tool, the Scottish Index of Multiple Deprivation (SIMD), was used as a marker of SED; the cohort was grouped numerically into those with greater deprivation (SIMD≤3) and those without. A survival analysis was performed to test for interaction between SIMD and time to either drop-out or live donor nephrectomy.

Results

Of 7765 patients attending clinic, 1298 reached ESKD; 113 received a pre-emptive transplant. Patients receiving pre-emptive transplant had higher SIMD (5±7 vs 4±5; p=0.003); SIMD, cardiovascular disease, referral age and proteinuria were independently associated with pre-emptive transplant on logistic regression.

1208 PLDs were evaluated between 2009 and 2018 with an age of 45.8±21.4 years, follow-up 3.4±8.5 months and SIMD of 4±5. The PLDs from deprived areas were assessed at younger age (42.9±21.6 vs 48.4±21.1 years; p<0.001). SED was not asssociated with likelihood of successful donation (8 vs 11%; p=0.13) but was associated with more frequent referral for psychological assessment (13 vs 9%; p=0.03); there was no difference in discussion of the National Kidney Sharing Scheme (7 vs 9%; p=0.22).

The cumulative incidence of successful donation was no different between groups (log rank p=0.27). In an analysis of the recipients of the PLDs, there was no association between SED and renal replacement therapy status (pre-emptive recipients 55 vs 62%; p=0.21), nor recipient eGFR (13.0±8.4 vs 13.1±7.6 ml/min/1.73m², p=0.56) at time of PLD approach.

In an evaluation by postal code sector, there was no association between lower SIMD and the number of PLDs per 100,000 population (r = -0.024, p=0.75).

Conclusion

Although SED is associated with reduced incidence of live and pre-emptive transplantation, in recipients in whom PLDs are assessed, deprivation does not affect outcome of the evaluation process. Resources should be focused on encouraging an approach of PLDs for all suitable patients nearing ESKD.