Abstract: SA-PO963
Does Live Donor and Preemptive Kidney Transplantation Reduce the Impact of Socioeconomic Deprivation on Graft Outcome?
Session Information
- Transplantation: Clinical - 3
October 26, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2102 Transplantation: Clinical
Authors
- Corr, Michael, Queen's University Belfast, Belfast, United Kingdom
- Beck, Jenni, Belfast City Hospital, Belfast, United Kingdom
- Maxwell, Alexander P., Queen's University Belfast, Belfast, United Kingdom
- O'Neill, Ciaran, Queen's University Belfast, Belfast, United Kingdom
- McKay, Gareth J., Queen's University Belfast, Belfast, United Kingdom
Background
Socioeconomic deprivation has been reported to adversely affect transplant outcomes from access to wait listing to post-transplant care. Individuals from lower socioeconomic backgrounds have lower rates of living donor transplants and face significant challenges post-transplant leading to higher rates of graft loss. The aim of this study was to assess the impact of socioeconomic deprivation on transplant outcomes in Northern Ireland, a region with universal healthcare but high socioeconomic deprivation.
Methods
A single-centre retrospective study included all 1,581 kidney transplant recipients from 2000-2020. A national tool allowed determination of socioeconomic deprivation status, using a multi-dimensional deprivation score. Concentration curves were calculated for pre-emptive and living donor transplantation across the study population ranked by summary deprivation score. For analysis of each individual deprivation score the population was divided into quintiles. Cox regression was used to assess risk of graft failure compared to least deprived quintile. Other variables such as age, live donor and pre-emptive transplantation were investigated for association with graft survival in a regression model.
Results
Concentration curves for pre-emptive and living donor transplantation lie above the line of equality suggesting both are more prevalent in lower socioeconomic groups. Univariate cox proportional hazards failed to identify significant associations between socioeconomic status and graft survival which remained non-significant following adjustment for pre-emptive transplantation (HR 0.64 p < 0.05), live donor transplantation (HR 0.79 p < 0.01) and increasing recipient age (HR 0.77 p < 0.05).
Conclusion
Our results differ from previous reports on impact of socioeconomic deprivation on transplant outcomes. The higher proportion of pre-emptive and live donor transplants in more deprived groups likely represents equitable access to transplantation, despite unequitable burden of end-stage kidney disease. Our region has high pre-emptive (24%) and live donor (42%) rates which may mitigate impact of deprivation on graft survival. These data demonstrate an opportunity to reduce the burden of socioeconomic deprivation on transplant outcomes through expanded access to pre-emptive and live donor transplantation.