Socioeconomic Deprivation and Kidney Transplant Outcomes

Socioeconomic deprivation adversely affects health outcomes, including those after kidney transplantation. Retrospective studies, including 92,844 patients in the US and 19,103 and 621 in 2 UK cohorts, reported higher mortality and graft rejection among deprived individuals. The persistence of these disparities in the UK, despite having universal health care, suggests that insurance coverage alone does not eliminate inequities. Whether similar patterns exist in Belgium remains unclear.

We studied 1891 kidney transplant recipients (2004-2021) at University Hospitals Leuven, by assessing socioeconomic deprivation using the Belgian Index of Multiple Deprivation (BIMD). The outcomes were all-cause graft failure, graft failure, mortality, and rejection, analyzed with Cox and competing risks models.

Socioeconomic deprivation was associated with all-cause graft failure in univariable analysis (hazard ratio [HR]: 1.07, 95% confidence interval [CI]: 1.00-1.14, P = 0.043), but not after adjustment (adjusted HR [aHR]: 1.03, 95% CI: 0.97-1.10, P = 0.315). No significant associations were observed for graft failure (aHR: 1.04, 95% CI: 0.94-1.15, P = 0.467) or mortality (aHR: 1.04, 95% CI: 0.96-1.13, P = 0.366). In contrast, rejection risk differed significantly across deprivation groups (P = 0.030), driven by higher rates of T-cell-mediated rejection (TCMR) (aHR: 1.08, 95% CI: 1.00-1.16, P = 0.036), whereas antibody-mediated rejection (AMR) showed no association (aHR: 1.00, 95% CI: 0.88-1.15, P = 0.984).

Socioeconomic deprivation in Belgium was associated with rejection, specifically TCMR, and univariably with all-cause graft failure. We lacked evidence of associations with graft failure or mortality separately. These findings suggest that universal health care may mitigate some adverse posttransplantation outcomes because of socioeconomic deprivation. Future studies should evaluate whether deprivation affects access to transplantation itself.