Social determinants of health and pediatric kidney transplant outcomes

Understanding how social determinants of health (SDoH) affect clinical outcomes is important in achieving health equity. The impact of SDoH on pediatric transplant recipients is poorly understood. We investigated the effect of SDoH on pediatric kidney allograft outcomes.

In a single-center retrospective pilot cohort study, data were extracted from electronic health records using bioinformatics.

patients 0-18 years old who received a kidney transplant at our center from 9/25/2012-12/31/2022. Exposures were insurance type, distance to transplant center, language, and area deprivation index (ADI). Primary outcomes were graft survival, time to first biopsy-proven acute rejection (BPAR), and number of BPAR. Secondary outcomes were hospitalization and clinic attendance rates. Kaplan-Meier estimates were used for graft survival. Cox proportional hazards models estimated associations of exposure with outcome.

N = 78 participants were 37% female; 37% had living donor; median age at transplant 8.5 years [IQR 3, 14]; median follow-up 5.0 years [IQR 4.1, 7.0]. Insurance type, distance to transplant center, language, and ADI were not associated with higher risk of graft failure, time to first BPAR, or hospitalization rates. Public insurance was associated with increased BPAR episodes [IRR 3.01, 95% CI (1.04, 9.69)]. In a regression analysis, greater distance from the transplant center was associated with a higher rate of missed (either cancelled or no-show) clinic appointments [IRR = 1.04 cancellations per 10-mile increase, 95% CI (1.02, 1.06)].

Public insurance was associated with greater number of BPAR, which impacts long-term graft function. Greater distance to the transplant center was associated with lower clinic attendance, which delays care and may cause negative health effects. These are important SDoH to investigate in larger multi-center cohorts to develop effective strategies to reduce health inequities.